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Single-Use","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63600001_50242006001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9035","type":"HCPCS"},{"code":"50242006001","type":"NDC"}],"standard_charges":[{"gross_charge":689.52,"discounted_cash":689.52,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Gazyva: 1 Vial, Single-Use In 1 Carton (50242-070-01) / 40 Ml In 1 Vial, Single-Use","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63600001_50242007001","type":"CDM"},{"code":"636","type":"RC"},{"code":"J9301","type":"HCPCS"},{"code":"50242007001","type":"NDC"}],"standard_charges":[{"gross_charge":518.53,"discounted_cash":518.53,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on 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Single-Use","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63600001_50242012047","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3101","type":"HCPCS"},{"code":"50242012047","type":"NDC"}],"standard_charges":[{"gross_charge":562.28,"discounted_cash":562.28,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Actemra: 1 Vial, Single-Use In 1 Box (50242-136-01) / 10 Ml In 1 Vial, Single-Use","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63600001_50242013601","type":"CDM"},{"code":"636","type":"RC"},{"code":"J3262","type":"HCPCS"},{"code":"50242013601","type":"NDC"}],"standard_charges":[{"gross_charge":46.94,"discounted_cash":46.94,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying 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items."}]},{"description":"Sennosides and Docusate Sodium: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-432-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739043210","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739043210","type":"NDC"}],"standard_charges":[{"gross_charge":1.67,"discounted_cash":1.67,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Aspirin Chewable: 30 Blister Pack In 1 Box (63739-434-02) / 10 Tablet In 1 Blister 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UNIT-DOSE (63739-446-10) / 10 TABLET, EXTENDED RELEASE in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739044610","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739044610","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-478-10) / 10 CAPSULE, LIQUID FILLED in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739047810","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739047810","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Baclofen: 10 Blister Pack In 1 Box, Unit-Dose (63739-479-10) / 10 Tablet In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739047910","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739047910","type":"NDC"}],"standard_charges":[{"gross_charge":4.74,"discounted_cash":4.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-483-10) / 10 Tablet In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739048310","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739048310","type":"NDC"}],"standard_charges":[{"gross_charge":2.98,"discounted_cash":2.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hydroxyzine Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-486-10) / 10 Tablet In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739048610","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739048610","type":"NDC"}],"standard_charges":[{"gross_charge":3.08,"discounted_cash":3.08,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Lorazepam: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-500-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739050010","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739050010","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Zolpidem Tartrate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-526-10) / 10 TABLET, FILM COATED in 1 BLISTER 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for drug and supply items."}]},{"description":"Folic Acid: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-537-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739053710","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739053710","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-544-10) / 10 Tablet In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739054410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739054410","type":"NDC"}],"standard_charges":[{"gross_charge":3.98,"discounted_cash":3.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Spironolactone: 10 Blister Pack In 1 Box, Unit-Dose (63739-545-10) / 10 Tablet In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739054510","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739054510","type":"NDC"}],"standard_charges":[{"gross_charge":7.21,"discounted_cash":7.21,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Pantoprazole Sodium: 10 Blister Pack In 1 Box, Unit-Dose (63739-564-10) / 10 Tablet, Delayed Release In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739056410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739056410","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Tamsulosin Hydrochloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-567-10) / 10 Capsule In 1 Blister 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items."}]},{"description":"Amlodipine Besylate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-631-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739063110","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739063110","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"METFORMIN HYDROCHLORIDE: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-640-10) / 10 TABLET in 1 BLISTER 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variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ibuprofen: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-672-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739067210","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739067210","type":"NDC"}],"standard_charges":[{"gross_charge":0.97,"discounted_cash":0.97,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Losortan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-673-10) / 10 Tablet, Film Coated In 1 Blister 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items."}]},{"description":"Acyclovir: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-682-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739068210","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739068210","type":"NDC"}],"standard_charges":[{"gross_charge":6.12,"discounted_cash":6.12,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ibuprofen: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-684-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739068410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739068410","type":"NDC"}],"standard_charges":[{"gross_charge":1.03,"discounted_cash":1.03,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Losartan Potassium: 10 Blister Pack In 1 Box, Unit-Dose (63739-686-10) / 10 Tablet, Film Coated In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739068610","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739068610","type":"NDC"}],"standard_charges":[{"gross_charge":6.06,"discounted_cash":6.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ibuprofen: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-691-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739069110","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739069110","type":"NDC"}],"standard_charges":[{"gross_charge":1.89,"discounted_cash":1.89,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"voriconazole: 3 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-707-33) / 10 TABLET, FILM COATED in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739070733","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739070733","type":"NDC"}],"standard_charges":[{"gross_charge":300.76,"discounted_cash":300.76,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Hydroxychloroquine Sulfate: 10 Blister Pack In 1 Box, Unit-Dose (63739-777-10) / 10 Tablet, Film Coated In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739077710","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739077710","type":"NDC"}],"standard_charges":[{"gross_charge":36.26,"discounted_cash":36.26,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Levetiracetam: 10 Blister Pack In 1 Box, Unit-Dose (63739-795-10) / 10 Tablet, Film Coated In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739079510","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739079510","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Allopurinol: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-796-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739079610","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739079610","type":"NDC"}],"standard_charges":[{"gross_charge":5.15,"discounted_cash":5.15,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Gabapentin: 10 Blister Pack In 1 Carton (63739-904-10) / 10 Capsule In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739090410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739090410","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Sucralfate: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-943-10) / 10 TABLET in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739094310","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739094310","type":"NDC"}],"standard_charges":[{"gross_charge":3.09,"discounted_cash":3.09,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Paroxetine: 10 Blister Pack In 1 Box, Unit-Dose (63739-963-10) / 10 Tablet, Film Coated In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739096310","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739096310","type":"NDC"}],"standard_charges":[{"gross_charge":2.83,"discounted_cash":2.83,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Potassium Chloride: 10 Blister Pack In 1 Box, Unit-Dose (63739-972-10) / 10 Tablet, Extended Release In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739097210","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739097210","type":"NDC"}],"standard_charges":[{"gross_charge":5.98,"discounted_cash":5.98,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Gabapentin: 10 BLISTER PACK in 1 BOX, UNIT-DOSE (63739-984-10) / 10 CAPSULE in 1 BLISTER PACK","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739098410","type":"CDM"},{"code":"250","type":"RC"},{"code":"63739098410","type":"NDC"}],"standard_charges":[{"gross_charge":2.06,"discounted_cash":2.06,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Ziprasidone Hydrochloride: 4 Blister Pack In 1 Box, Unit-Dose (63739-988-32) / 10 Capsule In 1 Blister Pack","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739098832","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739098832","type":"NDC"}],"standard_charges":[{"gross_charge":27.79,"discounted_cash":27.79,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Lidocaine Hydrochloride: 1 Bottle In 1 Carton (63739-997-64) / 50 Ml In 1 Bottle","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63739099764","type":"CDM"},{"code":"637","type":"RC"},{"code":"63739099764","type":"NDC"}],"standard_charges":[{"gross_charge":368.74,"discounted_cash":368.74,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Mucinex: 500 Tablet, Extended Release In 1 Bottle (63824-008-50)","drug_information":{"unit":1.0,"type":"EA"},"code_information":[{"code":"63700001_63824000850","type":"CDM"},{"code":"637","type":"RC"},{"code":"63824000850","type":"NDC"}],"standard_charges":[{"gross_charge":4.07,"discounted_cash":4.07,"setting":"both","billing_class":"facility","additional_generic_notes":"Gross Charge Type: Pharmacy | Price is variable based on underlying billing methodology - especially, for drug and supply items."}]},{"description":"Mucinex Dm: 2 Blister Pack In 1 Carton (63824-056-34) / 20 Tablet, Extended Release In 1 Blister 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Digestive Malignancy Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Mcc","code_information":[{"code":"377","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14510.14,"maximum":27476.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27476.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23274.26,"additional_payer_notes":"MSDRG Base 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22182.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22024.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14510.14,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage With Cc","code_information":[{"code":"378","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7954.22,"maximum":14899.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14899.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12758.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10377.67},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10808.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11498.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7954.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4523.9,"10th_percentile":4523.9,"90th_percentile":4523.9,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Hemorrhage Without Cc/Mcc","code_information":[{"code":"379","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5243.8,"maximum":9620.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9620.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8411.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":6700.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6979.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7424.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7767.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7711.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5243.8,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complicated Peptic Ulcer Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uncomplicated Peptic Ulcer With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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Cc/Mcc","code_information":[{"code":"373","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5994.33,"maximum":10961.46,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10961.46},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5994.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9614.91,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Gastrointestinal Disorders And Peritoneal Infections With 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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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Esophageal Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral Without Cc/Mcc","code_information":[{"code":"355","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10772.96,"maximum":20147.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20147.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17279.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14032.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14614.86},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15547.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16265.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16149.17},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10772.96,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":117035.34,"10th_percentile":117035.34,"90th_percentile":117035.34,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal And Femoral With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal And Femoral Hernia Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Anal And Stomal Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Small And Large Bowel Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peritoneal Adhesiolysis With 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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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":27995.69,"maximum":54768.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54768.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27995.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27995.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27995.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44905.09,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rectal Resection With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":117383.84,"10th_percentile":117383.84,"90th_percentile":117383.84,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9157.35,"10th_percentile":9157.35,"90th_percentile":9157.35,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":94679.17,"10th_percentile":94679.17,"90th_percentile":94679.17,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":20000.21,"10th_percentile":20000.21,"90th_percentile":20000.21,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24880.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25913.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27567.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18914.28,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":141583.52,"10th_percentile":141583.52,"90th_percentile":141583.52,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small And Large Bowel Procedures With Mcc","code_information":[{"code":"329","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35931.18,"maximum":69394.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":69394.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35931.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35931.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35931.18,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57633.61,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device Without Mcc","code_information":[{"code":"322","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14007.2,"maximum":27340.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27340.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22467.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19042.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19833.27},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21099.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22072.83},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21915.44},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14007.2,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With Intraluminal Device With Mcc Or 4+ Arteries/Intraluminal","code_information":[{"code":"321","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21418.1,"maximum":43022.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43022.18},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21418.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21418.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21418.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34354.63,"additional_payer_notes":"MSDRG 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures Without Mcc","code_information":[{"code":"320","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18976.95,"maximum":34980.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34980.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30439.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24363.69},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25375.1},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26995.18},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28240.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28039.06},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18976.95,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endovascular Cardiac Valve Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concomitant Left Atrial Appendage Closure And Cardiac 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":12452.91,"10th_percentile":681.46,"90th_percentile":15074.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":45233.79,"10th_percentile":45233.79,"90th_percentile":45233.79,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30023.0,"10th_percentile":30023.0,"90th_percentile":83481.26,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4756.5,"10th_percentile":3691.75,"90th_percentile":6995.06,"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":"1 through 10","median_amount":7117.86,"10th_percentile":5848.27,"90th_percentile":7172.32,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":34133.94,"10th_percentile":249.83,"90th_percentile":53283.05,"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":11915.51,"10th_percentile":11915.51,"90th_percentile":11915.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":4173.3,"10th_percentile":4173.3,"90th_percentile":4173.3,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"12","median_amount":7761.34,"10th_percentile":5318.58,"90th_percentile":12580.79,"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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":140.11,"10th_percentile":140.11,"90th_percentile":140.11,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":12229.06,"10th_percentile":12229.06,"90th_percentile":12229.06,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5609.64,"10th_percentile":5303.19,"90th_percentile":8668.21,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System Diagnoses With Mcc","code_information":[{"code":"314","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16500.2,"maximum":32544.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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":6609.1,"10th_percentile":235.67,"90th_percentile":8724.06,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":40498.5,"10th_percentile":27906.3,"90th_percentile":63038.04,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":18512.0,"10th_percentile":18512.0,"90th_percentile":89605.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":15023.85,"10th_percentile":15023.85,"90th_percentile":15023.85,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":43985.02,"10th_percentile":257.9,"90th_percentile":82237.15,"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":35166.07,"10th_percentile":35166.07,"90th_percentile":35166.07},{"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":8898.03,"10th_percentile":8898.03,"90th_percentile":8898.03,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5152.91,"10th_percentile":5152.91,"90th_percentile":5152.91,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8117.02,"10th_percentile":8117.02,"90th_percentile":8117.02,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":23939.58,"10th_percentile":23939.58,"90th_percentile":23939.58,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":11210.6,"10th_percentile":11210.6,"90th_percentile":11210.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":8599.59,"10th_percentile":376.18,"90th_percentile":11726.96,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5937.07,"maximum":10780.1,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Syncope And 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Angina 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders Without 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrhythmia And Conduction Disorders With Mcc","code_information":[{"code":"308","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9681.98,"maximum":18226.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18226.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9681.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15529.9,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 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":4763.58,"10th_percentile":4763.58,"90th_percentile":4763.58},{"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Congenital And Valvular Disorders With Mcc","code_information":[{"code":"306","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12558.76,"maximum":22630.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22630.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12558.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20144.25,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6208.66,"maximum":11345.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11345.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9958.69,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7901.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8229.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8755.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6208.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9573.66,"maximum":17754.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17754.75},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15356.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12366.05},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12879.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13701.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14333.73},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14231.53},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9573.66,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8723.47,"10th_percentile":8723.47,"90th_percentile":8723.47,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Atherosclerosis With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With 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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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral Vascular Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained Without Cc/Mcc","code_information":[{"code":"298","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":3887.43,"maximum":6673.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6673.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3887.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3887.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":3887.43,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6235.44,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Arrest, Unexplained With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8313.51,"maximum":11936.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11936.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8313.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8658.62},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9211.44},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9636.35},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9567.64}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12924.99,"maximum":18557.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18557.25},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12924.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13461.54},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14321.0},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14981.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14874.78}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure And Shock Without Cc/Mcc","code_information":[{"code":"293","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4745.51,"maximum":8297.04,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8297.04},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7611.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":5778.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6018.72},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6402.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4745.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute And Subacute Endocarditis With Mcc","code_information":[{"code":"288","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":21305.14,"maximum":41278.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":41278.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21305.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21305.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":21305.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34173.44,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Mcc","code_information":[{"code":"260","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25534.41,"maximum":51486.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51486.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25534.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25534.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25534.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40957.19,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Upper Limb And Toe Amputation For Circulatory System Disorders With 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":24.62,"10th_percentile":24.62,"90th_percentile":24.62,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13247.06,"10th_percentile":13247.06,"90th_percentile":13247.06,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":21237.05,"maximum":39540.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures Without Cc/Mcc","code_information":[{"code":"254","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14151.89,"maximum":26437.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26437.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22699.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18413.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19177.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20402.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21343.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21191.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14151.89,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9342.87,"10th_percentile":9342.87,"90th_percentile":9342.87,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":12216.6,"10th_percentile":12216.6,"90th_percentile":12216.6,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Cc","code_information":[{"code":"253","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":20449.38,"maximum":38581.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38581.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32800.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26872.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27987.6},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29774.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31147.93},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30925.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":20449.38,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":19526.56,"10th_percentile":19526.56,"90th_percentile":19526.56,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25938.97,"10th_percentile":25938.97,"90th_percentile":25938.97,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Vascular Procedures With Mcc","code_information":[{"code":"252","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27356.57,"maximum":51840.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51840.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27356.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27356.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27356.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43879.94,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures Without Intraluminal Device Without Mcc","code_information":[{"code":"251","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11929.71,"maximum":23614.06,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23614.06},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19135.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16447.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17129.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18223.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19064.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18928.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11929.71,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Permanent Cardiac Pacemaker Implant With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25731.64,"10th_percentile":25731.64,"90th_percentile":25731.64,"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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":25070.17,"maximum":51263.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":51263.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25070.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25070.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25070.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40212.55,"additional_payer_notes":"MSDRG Base 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Circulatory System Disorders Except Upper Limb And Toe With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pleural Effusion Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12424.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19277.58},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19140.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12424.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12424.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12424.9,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":12104.61,"10th_percentile":12104.61,"90th_percentile":12104.61,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma Without Cc/Mcc","code_information":[{"code":"185","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6451.61,"maximum":11751.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11751.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Trauma With Cc","code_information":[{"code":"184","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8599.52,"maximum":16140.68,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16140.68},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13793.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11241.86},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11708.55},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12456.08},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8599.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Neoplasms With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Infections And Inflammations With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism Without 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Embolism With Mcc Or Acute Cor Pulmonale","code_information":[{"code":"175","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10994.25,"maximum":21295.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21295.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10994.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17634.78,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis With Principal Diagnosis Pulmonary Embolism","code_information":[{"code":"173","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23395.79,"maximum":46372.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46372.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37526.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":32298.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":33639.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":35786.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37437.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37170.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23395.79,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Cc","code_information":[{"code":"167","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14319.79,"maximum":27612.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27612.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22968.94,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19232.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20030.61},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21309.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22292.45},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22133.49},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14319.79,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System O.R. Procedures With Mcc","code_information":[{"code":"166","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29286.29,"maximum":58200.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58200.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46975.21,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":40535.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42218.74},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":44914.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46986.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46651.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29286.29,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures Without Cc/Mcc","code_information":[{"code":"165","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15177.1,"maximum":28169.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28169.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15177.1,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24344.07,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Chest Procedures With Cc","code_information":[{"code":"164","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":19895.38,"maximum":38036.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38036.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31912.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26492.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27591.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":29353.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30707.48},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30488.52},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19895.38,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12166.13,"10th_percentile":12166.13,"90th_percentile":12166.13,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Dental And Oral Diseases Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3213.94,"10th_percentile":3213.94,"90th_percentile":3213.94,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7405.64,"maximum":14213.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11475.04},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11393.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7405.64,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13649.73,"maximum":24746.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24746.03},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21894.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17235.42},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17950.91},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19097.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13649.73,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses Without 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat Diagnoses With 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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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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Otitis Media And Uri Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ear, Nose, Mouth And Throat Malignancy Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10204.26,"maximum":18811.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18811.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10204.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16367.63,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16749.34,"maximum":34667.71,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":34667.71},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16749.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16749.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16749.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":26865.94,"additional_payer_notes":"MSDRG Base 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth And Throat O.R. Procedures Without Cc/Mcc","code_information":[{"code":"145","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9668.83,"maximum":17904.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17904.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15508.8,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12470.26},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12987.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13817.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14454.52},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14351.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9668.83,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head And Neck Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures With 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14720.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15331.84},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16310.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17063.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16941.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11919.65,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":42036.05,"10th_percentile":42036.05,"90th_percentile":42036.05,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sinus And Mastoid Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye Without Mcc","code_information":[{"code":"125","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6306.92,"maximum":12478.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12478.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10116.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8691.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9052.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9630.14},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6306.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":11411.7,"10th_percentile":11411.7,"90th_percentile":11411.7,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22224.04,"10th_percentile":22224.04,"90th_percentile":22224.04,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":18324.68,"10th_percentile":18324.68,"90th_percentile":18324.68,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of The Eye With Mcc Or Thrombolytic Agent","code_information":[{"code":"124","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10603.51,"maximum":19704.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19704.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17008.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13723.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14293.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15206.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10603.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15907.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6732.37,"10th_percentile":6732.37,"90th_percentile":6732.37,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 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":175.14,"10th_percentile":175.14,"90th_percentile":175.14,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7919.54,"10th_percentile":7919.54,"90th_percentile":7919.54,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological Eye Disorders","code_information":[{"code":"123","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6545.23,"maximum":12138.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12138.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6545.23,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10498.55,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections Without Cc/Mcc","code_information":[{"code":"122","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6446.2,"maximum":10339.70,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10251.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6446.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10339.7,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intraocular Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Orbital Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7349.93,"maximum":13928.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13928.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7349.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11789.29,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":11245.66,"10th_percentile":11245.66,"90th_percentile":11245.66,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15351.97,"maximum":30002.33,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30002.33},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23153.39},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24221.43},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24048.71},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15351.97,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis Without Cc/Mcc","code_information":[{"code":"099","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10907.59,"maximum":21055.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21055.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10907.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10907.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10907.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17495.77,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With Cc","code_information":[{"code":"098","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18122.74,"maximum":32781.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32781.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29068.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":22832.14},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23779.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":25298.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18122.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Bacterial Infection Of Nervous System Except Viral Meningitis With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bacterial And Tuberculous Infections Of Nervous System Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System Without 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8308.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8653.14},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6527.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6527.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9205.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6527.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9980.87,"10th_percentile":9980.87,"90th_percentile":9980.87,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":53801.18,"10th_percentile":53801.18,"90th_percentile":53801.18,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11145.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11607.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12348.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8281.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4428.25,"10th_percentile":4428.25,"90th_percentile":4428.25,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders Of Nervous System With 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":33669.91,"10th_percentile":33669.91,"90th_percentile":33669.91,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Concussion Without Cc/Mcc","code_information":[{"code":"090","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6735.57,"maximum":12954.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12954.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6735.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10803.85,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour Without 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12035.37,"10th_percentile":12035.37,"90th_percentile":12035.37,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma <1 Hour With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Stupor And Coma >1 Hour With Mcc","code_information":[{"code":"082","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18050.78,"maximum":35063.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35063.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18050.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18050.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18050.78,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28953.45,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":78775.26,"10th_percentile":78775.26,"90th_percentile":78775.26,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma Without Mcc","code_information":[{"code":"081","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7295.76,"maximum":13674.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13674.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11702.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9524.01},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9919.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10552.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11039.46},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10960.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7295.76,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nontraumatic Stupor And Coma With Mcc","code_information":[{"code":"080","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14370.86,"maximum":30041.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30041.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23050.86,"additional_payer_notes":"MSDRG Base 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24253.15},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24080.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14370.86,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":7017.74,"maximum":10075.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10075.84},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7017.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7309.07},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7775.72},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8134.41},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8076.4}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10502.93,"maximum":15079.75,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15079.75},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10502.93},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10938.94},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11637.34},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12174.16},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12087.35}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16275.44,"maximum":23367.72,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23367.72},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16275.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16951.08},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18033.33},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18865.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18730.67}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis Without Cc/Mcc","code_information":[{"code":"076","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6751.05,"maximum":13857.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13857.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10828.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9651.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10052.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10693.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6751.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Meningitis With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders Without Mcc","code_information":[{"code":"074","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8341.86,"maximum":15753.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15753.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8341.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13380.34,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial And Peripheral Nerve Disorders With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders Without Cc/Mcc","code_information":[{"code":"072","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6217.17,"maximum":11336.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11336.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6217.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6217.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6217.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9972.34,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cerebrovascular Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient Ischemia Without 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction Without Mcc","code_information":[{"code":"068","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7054.36,"maximum":13323.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13323.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11315.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9279.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9665.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10282.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7054.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Precerebral Occlusion Without Infarction With Mcc","code_information":[{"code":"067","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11730.08,"maximum":22001.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22001.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11730.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11730.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11730.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18815.05,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction Without Cc/Mcc","code_information":[{"code":"066","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5661.62,"maximum":10402.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10402.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5661.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9081.24,"additional_payer_notes":"MSDRG Base 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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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With Cc Or Tpa In 24 Hours","code_information":[{"code":"065","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8183.25,"maximum":15369.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15369.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13125.93,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10705.03},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11149.43},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11861.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8183.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Hemorrhage Or Cerebral Infarction With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Degenerative Nervous System Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Nervous System Neoplasms With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Disorders And Injuries With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures Without 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21443.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21290.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13734.07,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":339.19,"10th_percentile":339.19,"90th_percentile":339.19,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With Cc Or Peripheral 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Peripheral, Cranial Nerve And Other Nervous System Procedures With 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With 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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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extracranial Procedures With 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15398.39,"maximum":27702.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27702.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15398.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15398.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15398.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24699.02,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Carotid Artery Stent Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":30315.36,"maximum":58766.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58766.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30315.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30315.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30315.36,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48625.84,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ventricular Shunt Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":12475.02,"10th_percentile":12475.02,"90th_percentile":12475.02,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Cc Or Spinal Neurostimulators","code_information":[{"code":"029","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":26763.11,"maximum":50726.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50726.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42928.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":35330.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36797.51},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":39146.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40952.66},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40660.64},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26763.11,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":175735.45,"10th_percentile":175735.45,"90th_percentile":175735.45,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22558.59,"10th_percentile":22558.59,"90th_percentile":22558.59,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures With Mcc","code_information":[{"code":"028","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":46854.88,"maximum":91873.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":91873.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":75155.23,"additional_payer_notes":"MSDRG Base 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":74171.1},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":73642.22},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":46854.88,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Craniotomy And Endovascular Intracranial Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial Vascular Procedures With Principal Diagnosis Hemorrhage Without Cc/Mcc","code_information":[{"code":"022","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24951.01,"maximum":53354.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53354.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24951.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24951.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24951.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40021.42,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lung 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":66227.8,"10th_percentile":66227.8,"90th_percentile":66227.8,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":555295.36,"10th_percentile":555295.36,"90th_percentile":555295.36,"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":"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ecmo Or Tracheostomy With Mv >96 Hours Or Principal Diagnosis Except Face, Mouth And Neck With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":124448.8,"10th_percentile":124448.8,"90th_percentile":124448.8,"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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Transplant Or Implant Of Heart Assist System Without Mcc","code_information":[{"code":"002","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":88045.03,"maximum":166540.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":166540.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88045.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88045.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":88045.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141224.23,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammatory Bowel Disease Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Mcc","code_information":[{"code":"388","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11792.75,"maximum":22216.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22216.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18915.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15473.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16115.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17144.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11792.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction With Cc","code_information":[{"code":"389","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6477.14,"maximum":12116.09,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12116.09},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10389.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8438.77},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8789.09},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9350.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9781.54},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9711.79},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6477.14,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Gastrointestinal Obstruction Without Cc/Mcc","code_information":[{"code":"390","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4575.29,"maximum":8268.32,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8268.32},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7338.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":5758.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":5997.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6380.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":6675.17},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6627.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4575.29,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":4598.82,"10th_percentile":4598.82,"90th_percentile":4598.82,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":2238.55,"10th_percentile":2238.55,"90th_percentile":2238.55,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10179.5,"maximum":19418.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19418.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care 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through 10","median_amount":22940.87,"10th_percentile":22940.87,"90th_percentile":22940.87,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6070.54,"10th_percentile":6070.54,"90th_percentile":6070.54,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 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":18419.8,"10th_percentile":18419.8,"90th_percentile":18419.8},{"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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":11321.31,"10th_percentile":11321.31,"90th_percentile":11321.31,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":3358.42,"10th_percentile":3358.42,"90th_percentile":3358.42,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Esophagitis, Gastroenteritis And Miscellaneous Digestive Disorders Without Mcc","code_information":[{"code":"392","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6398.22,"maximum":11792.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38655.0,"10th_percentile":38655.0,"90th_percentile":38655.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4772.49,"10th_percentile":4772.49,"90th_percentile":4772.49,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":973.0,"10th_percentile":973.0,"90th_percentile":973.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Mcc","code_information":[{"code":"393","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12740.59,"maximum":25025.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25025.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20435.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17430.15},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18153.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19312.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20203.64},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20059.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12740.59,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":46113.03,"10th_percentile":46113.03,"90th_percentile":46113.03,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses With Cc","code_information":[{"code":"394","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7606.03,"maximum":14225.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14225.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12200.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9908.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10319.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10978.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11484.8},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11402.91},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7606.03,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":37629.49,"10th_percentile":37629.49,"90th_percentile":37629.49,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":427.78,"10th_percentile":427.78,"90th_percentile":427.78,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":7985.23,"10th_percentile":7985.23,"90th_percentile":7985.23,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System Diagnoses Without Cc/Mcc","code_information":[{"code":"395","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5387.72,"maximum":9617.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9617.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8641.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":6698.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6976.89},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7422.33},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7764.72},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7709.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5387.72,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":6423.49,"10th_percentile":6423.49,"90th_percentile":6423.49,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Mcc","code_information":[{"code":"397","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":18896.48,"maximum":37443.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":37443.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30309.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":26079.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27162.08},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":28896.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30229.2},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30013.65},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18896.48,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures With Cc","code_information":[{"code":"398","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12077.49,"maximum":22870.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22870.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19372.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15929.13},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16590.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17649.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18463.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18332.12},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12077.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":53998.1,"10th_percentile":53998.1,"90th_percentile":53998.1,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":9320.31,"10th_percentile":9320.31,"90th_percentile":9320.31,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Appendix Procedures Without Cc/Mcc","code_information":[{"code":"399","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9223.16,"maximum":16988.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16988.52},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14793.95,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11832.38},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12323.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13110.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13715.14},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13617.35},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9223.16,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":170517.54,"10th_percentile":148387.32,"90th_percentile":185836.33,"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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":47392.39,"10th_percentile":47392.39,"90th_percentile":47392.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27348.02,"10th_percentile":27348.02,"90th_percentile":30632.99,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":42693.69,"maximum":82039.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pancreas, Liver And Shunt Procedures Without 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Without Cc/Mcc","code_information":[{"code":"413","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13214.12,"maximum":25123.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25123.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21195.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17498.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18224.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19388.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20282.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20138.31},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13214.12,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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With Mcc","code_information":[{"code":"414","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27931.47,"maximum":52949.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":52949.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44802.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36879.21},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38410.18},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40862.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42747.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42442.61},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27931.47,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":26728.3,"maximum":53336.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":53336.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26728.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26728.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26728.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":42872.19,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hepatobiliary Diagnostic Procedures Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With Mcc Or 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29293.19,"10th_percentile":29293.19,"90th_percentile":29293.19,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Combined Anterior And Posterior Spinal Fusion Except Cervical Without 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Combined Anterior And Posterior Cervical Spinal Fusion Without 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15594.92,"maximum":29607.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29607.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15594.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15594.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15594.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25014.25,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy Of Hepatobiliary System Or Pancreas Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Mcc","code_information":[{"code":"438","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12979.67,"maximum":25145.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25145.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12979.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20819.39,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":127778.33,"10th_percentile":127778.33,"90th_percentile":127778.33,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":4787.94,"10th_percentile":4787.94,"90th_percentile":4787.94,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy With Cc","code_information":[{"code":"439","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6874.85,"maximum":13000.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Pancreas Except Malignancy Without Cc/Mcc","code_information":[{"code":"440","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5174.16,"maximum":9296.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis With 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":12262.04,"10th_percentile":12262.04,"90th_percentile":12262.04,"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. 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":7021.72,"10th_percentile":6583.68,"90th_percentile":7308.84,"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":"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Liver Except Malignancy, Cirrhosis Or Alcoholic Hepatitis Without Cc/Mcc","code_information":[{"code":"443","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5780.0,"maximum":10618.39,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of The Biliary Tract Without 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical With Mcc Or Custom-Made Anatomically Designed Interbody","code_information":[{"code":"447","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52064.48,"maximum":101320.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":101320.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52064.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52064.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52064.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":83511.43,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Multiple Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"448","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":33178.98,"maximum":61709.4,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":61709.4},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33178.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33178.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33178.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53219.08,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":276118.72,"10th_percentile":276118.72,"90th_percentile":276118.72,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":109922.4,"10th_percentile":109922.4,"90th_percentile":109922.4,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29001.29,"10th_percentile":29001.29,"90th_percentile":29001.29,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30113.59,"10th_percentile":30113.59,"90th_percentile":30113.59,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level 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":41603.49,"maximum":77827.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial 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Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62831.49},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62383.47},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41603.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41603.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41603.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial 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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":38433.41,"10th_percentile":38433.41,"90th_percentile":38433.41,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Single Level Spinal Fusion Except Cervical Without Mcc","code_information":[{"code":"451","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25361.09,"maximum":46635.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":46635.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25361.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40679.19,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":23199.66,"10th_percentile":23199.66,"90th_percentile":23199.66,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":185262.79,"10th_percentile":185262.79,"90th_percentile":185262.79,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":37652.29,"10th_percentile":37652.29,"90th_percentile":39414.11,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions With","code_information":[{"code":"456","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":65386.77,"maximum":127985.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Fusion Except Cervical With Spinal Curvature, Malignancy, Infection Or Extensive Fusions 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bilateral Or Multiple Major Joint Procedures Of Lower Extremity Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":44465.56,"maximum":81620.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":81620.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44465.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44465.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44465.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":71322.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":56848.25},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59208.2},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44465.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44465.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":62988.36},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":44465.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":24465.87,"maximum":44562.19,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44562.19},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39243.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":31037.23},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32325.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":34389.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35975.87},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35719.34},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24465.87,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":31039.09,"10th_percentile":31039.09,"90th_percentile":31039.09,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":127514.16,"10th_percentile":127514.16,"90th_percentile":177020.42,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7807.04,"10th_percentile":7807.04,"90th_percentile":7807.04,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":14476.86,"maximum":26234.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":26234.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23220.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18272.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19030.78},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20245.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":40642.5,"maximum":76990.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":76990.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":65190.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":53623.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":55849.12},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59414.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":40642.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Revision Of Hip Or Knee Replacement With 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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":25683.89,"10th_percentile":25683.89,"90th_percentile":25683.89,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":155243.22,"10th_percentile":155243.22,"90th_percentile":155243.22,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":119068.54,"10th_percentile":84172.85,"90th_percentile":215277.73,"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":"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":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26913.96,"10th_percentile":26913.96,"90th_percentile":26913.96,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":21628.56,"maximum":39644.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":165887.42,"10th_percentile":165887.42,"90th_percentile":165887.42,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Circulatory Disorders Except Ami, With Cardiac Catheterization With 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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. 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired Without Cc/Mcc","code_information":[{"code":"285","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5000.07,"maximum":8482.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8482.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5000.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8020.11,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Expired With Mcc","code_information":[{"code":"283","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15692.41,"maximum":29551.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29551.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15692.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25170.63,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive Without 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Myocardial Infarction, Discharged Alive With Cc","code_information":[{"code":"281","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7477.59,"maximum":13931.16,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13931.16},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7477.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11994.05,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ultrasound Accelerated And Other Thrombolysis Of Peripheral Vascular Structures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant Without Mcc","code_information":[{"code":"277","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36101.41,"maximum":70308.7,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":70308.7},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36101.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36101.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36101.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57906.66,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Mcc Or Carotid Sinus 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Defibrillator Implant With Cardiac Catheterization And 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures Without Mcc","code_information":[{"code":"274","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25835.4,"maximum":47164.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47164.65},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25835.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25835.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25835.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41439.98,"additional_payer_notes":"MSDRG Base 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous And Other Intracardiac Procedures With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":36256.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37761.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":40172.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":42025.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":41725.46},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27882.72,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":26072.29,"10th_percentile":26072.29,"90th_percentile":26072.29,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Major Cardiovascular Procedures With Mcc","code_information":[{"code":"270","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":41191.08,"maximum":77572.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":77572.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66070.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":54028.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":56271.19},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":59863.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62625.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":62178.74},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41191.08,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":117794.36,"10th_percentile":117794.36,"90th_percentile":117794.36,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":179040.0,"10th_percentile":179040.0,"90th_percentile":179040.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":81166.41,"10th_percentile":81166.41,"90th_percentile":81166.41,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3648.37,"10th_percentile":3648.37,"90th_percentile":3648.37,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25974.78,"10th_percentile":25974.78,"90th_percentile":25974.78,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12382.9,"10th_percentile":12382.9,"90th_percentile":12382.9,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":33042.81,"maximum":62876.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62876.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33042.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33042.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":33042.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53000.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43792.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aortic And Heart Assist Procedures Except Pulsation Balloon With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endovascular Cardiac Valve Replacement And Supplement Procedures Without Mcc","code_information":[{"code":"267","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":37202.44,"maximum":71097.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":71097.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37202.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":59672.71,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Circulatory System O.R. 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":115557.18,"10th_percentile":115557.18,"90th_percentile":115557.18,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22791.56,"10th_percentile":15654.34,"90th_percentile":35005.06,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12769.11,"10th_percentile":12769.11,"90th_percentile":12769.11,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein Ligation And Stripping","code_information":[{"code":"263","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":24022.52,"maximum":40531.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":40531.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38532.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":28229.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":29401.83},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":31279.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32721.86},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32488.54},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24022.52,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement Without Cc/Mcc","code_information":[{"code":"262","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12977.35,"maximum":22937.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22937.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20815.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15975.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16638.64},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17700.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18517.46},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18385.42},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12977.35,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Revision Except Device Replacement With Cc","code_information":[{"code":"261","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14993.72,"maximum":28675.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28675.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14993.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14993.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14993.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24049.93,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hip And Knee Joint Replacement Or Reattachment Of Lower Extremity With Mcc Or Total Ankle Repl","code_information":[{"code":"469","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23835.27,"maximum":49396.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49396.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38231.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":34404.53},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":35832.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":38120.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23835.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":16545.43,"10th_percentile":16545.43,"90th_percentile":16545.43,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20692.4,"10th_percentile":20692.4,"90th_percentile":20692.4,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major 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":15290.84,"maximum":28495.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28495.56},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24526.51,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19846.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20670.85},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21990.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23004.99},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22840.95},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15290.84,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":96157.0,"10th_percentile":96157.0,"90th_percentile":96157.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":22021.25,"10th_percentile":22021.25,"90th_percentile":22021.25,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":37727.81,"maximum":73403.84,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":73403.84},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":60515.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":51125.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":53247.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":56647.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":37727.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59260.26},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":23161.35,"maximum":43782.36,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43782.36},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37150.81,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":30494.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31759.98},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":33787.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23161.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":13049.73,"10th_percentile":13049.73,"90th_percentile":13049.73,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":120323.16,"10th_percentile":120323.16,"90th_percentile":153761.39,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17882.75,"10th_percentile":17882.75,"90th_percentile":17882.75,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":21794.53,"10th_percentile":21794.53,"90th_percentile":21794.53,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":19255.5,"maximum":35775.49,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":35775.49},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30885.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24917.36},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25951.76},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":27608.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28882.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28676.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19255.5,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":21335.37,"10th_percentile":21335.37,"90th_percentile":21366.79,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":94493.01,"10th_percentile":94493.01,"90th_percentile":94493.01,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation For Musculoskeletal System And Connective Tissue Disorders With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Amputation 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":9497.83,"maximum":17576.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17576.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9497.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15234.52,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint With Cc","code_information":[{"code":"481","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":16572.16,"maximum":31357.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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":13577.36,"10th_percentile":13577.36,"90th_percentile":13577.36,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip And Femur Procedures Except Major Joint Without Cc/Mcc","code_information":[{"code":"482","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12985.86,"maximum":23975.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Joint Or Limb Reattachment Procedures Of Upper 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures With Principal Diagnosis Of Infection With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Knee Procedures Without Principal Diagnosis Of Infection Without Cc/Mcc","code_information":[{"code":"489","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9007.28,"maximum":18718.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":18807.14,"10th_percentile":18807.14,"90th_percentile":18807.14,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":92837.33,"10th_percentile":92837.33,"90th_percentile":92837.33,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":95777.72,"10th_percentile":95777.72,"90th_percentile":95777.72,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":95876.12,"10th_percentile":95876.12,"90th_percentile":95876.12,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 With Cc/Mcc","code_information":[{"code":"498","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23708.38,"maximum":38155.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":38155.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23708.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23708.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23708.38,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":38028.24,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve 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":41628.25,"maximum":80042.98,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":80042.98},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41628.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41628.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":41628.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":66771.71,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures Without Cardiac Catheterization With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve And Other Major Cardiothoracic Procedures With Cardiac Catheterization Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory System Diagnosis With Ventilator Support <=96 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses Without 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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":183.05,"10th_percentile":183.05,"90th_percentile":183.05,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8606.45,"10th_percentile":8606.45,"90th_percentile":10294.49,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Respiratory System Diagnoses With Mcc","code_information":[{"code":"205","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14533.35,"maximum":28528.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23031.83},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22867.6},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14533.35,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":10004.82,"10th_percentile":10004.82,"90th_percentile":10004.82,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":8193.37,"10th_percentile":8193.37,"90th_percentile":8193.37,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Respiratory Signs And Symptoms","code_information":[{"code":"204","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6613.32,"maximum":12255.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":26028.8,"10th_percentile":26028.8,"90th_percentile":35885.43,"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":921.85,"10th_percentile":921.85,"90th_percentile":921.85},{"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7774.01,"10th_percentile":7774.01,"90th_percentile":7774.01,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma Without Cc/Mcc","code_information":[{"code":"203","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5550.2,"maximum":10523.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":26279.43,"10th_percentile":26279.43,"90th_percentile":26279.43,"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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Bronchitis And Asthma With Cc/Mcc","code_information":[{"code":"202","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7880.71,"maximum":14609.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14609.74},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12640.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10175.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10597.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11274.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7880.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27385.15,"10th_percentile":27385.15,"90th_percentile":27385.15,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5132.15,"10th_percentile":5132.15,"90th_percentile":5132.15,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pneumothorax Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8871.88,"maximum":16736.14,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16736.14},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14230.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11656.59},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12140.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12915.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13511.39},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13415.04},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8871.88,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":37322.88,"10th_percentile":37322.88,"90th_percentile":37322.88,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":648.55,"10th_percentile":648.55,"90th_percentile":648.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":14015.71,"maximum":26677.47,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21537.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21383.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14015.71,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5907.67,"maximum":10585.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10585.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9475.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7372.47},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7678.53},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8168.77},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5907.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Interstitial Lung Disease With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Simple Pneumonia And Pleurisy With Mcc","code_information":[{"code":"193","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10536.2,"maximum":19915.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19915.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10536.2,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16900.06,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5333.55,"maximum":9781.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9781.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5333.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8555.01,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Chronic Obstructive Pulmonary Disease With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8936.87,"maximum":16976.43,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16976.43},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8936.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8936.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8936.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14334.74,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pulmonary Edema And Respiratory 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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":"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":611.18,"10th_percentile":611.18,"90th_percentile":611.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12218.69,"maximum":25592.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17543.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15955.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25592.61,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":24853.52,"maximum":47885.54,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47885.54},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39865.05,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":33351.92},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":34736.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":36954.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":24853.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24486.6,"10th_percentile":24486.6,"90th_percentile":24486.6,"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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Soft Tissue Procedures With 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":18788.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19567.97},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":20817.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21777.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21622.28},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13891.92,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":49325.91,"10th_percentile":49325.91,"90th_percentile":49325.91,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":26051.19,"10th_percentile":26051.19,"90th_percentile":26051.19,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10779.92,"maximum":21114.37,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21114.37},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10779.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10779.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10779.92,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17290.99,"additional_payer_notes":"MSDRG Base 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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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Foot Procedures Without Cc/Mcc","code_information":[{"code":"505","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14237.78,"maximum":26532.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Thumb Or Joint 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures With Cc/Mcc","code_information":[{"code":"507","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14343.01,"maximum":29290.51,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29290.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14343.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23006.19,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Shoulder Or Elbow Joint Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures With 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schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23931.04},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23760.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16455.32,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":140468.98,"10th_percentile":140468.98,"90th_percentile":140468.98,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13162.34,"10th_percentile":13162.34,"90th_percentile":13162.34,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12847.6,"10th_percentile":12847.6,"90th_percentile":12847.6,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Shoulder, Elbow Or Forearm Procedures, Except Major Joint Procedures Without Cc/Mcc","code_information":[{"code":"512","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13174.66,"maximum":24297.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19615.55},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19475.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13174.66,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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Procedures Without Cc/Mcc","code_information":[{"code":"517","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12256.22,"maximum":22557.66,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22557.66},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19658.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15711.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16363.46},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17408.19},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18211.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18081.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12256.22,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1510.9,"10th_percentile":1510.9,"90th_percentile":1510.9,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14835.21,"10th_percentile":14835.21,"90th_percentile":14835.21,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11657.54,"10th_percentile":11657.54,"90th_percentile":11657.54,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Mcc Or Disc Device Or Neurostimulator","code_information":[{"code":"518","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":29283.19,"maximum":54161.97,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":54161.97},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":46970.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":37723.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":39289.41},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":41797.86},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":43725.94},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43414.15},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":29283.19,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion With Cc","code_information":[{"code":"519","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15842.52,"maximum":29798.3,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29798.3},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25411.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":20754.29},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21615.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22995.94},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15842.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":56247.96,"10th_percentile":56247.96,"90th_percentile":56247.96,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back And Neck Procedures Except Spinal Fusion Without 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15084.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15711.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16714.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17485.25},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17360.57},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11925.06,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":22683.97,"10th_percentile":22683.97,"90th_percentile":22683.97,"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. 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture With Mcc","code_information":[{"code":"521","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22574.08,"maximum":44048.35,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":44048.35},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22574.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22574.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22574.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36208.82,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hip Replacement With Principal Diagnosis Of Hip Fracture Without 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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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fractures Of Femur Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh With Cc/Mcc","code_information":[{"code":"537","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7749.95,"maximum":13887.34,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sprains, Strains, And Dislocations Of Hip, Pelvis And Thigh Without Cc/Mcc","code_information":[{"code":"538","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5939.39,"maximum":10148.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10148.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5939.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9526.78,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Osteomyelitis Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Pathological Fractures And Musculoskeletal And Connective Tissue Malignancy Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With 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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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders With 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Connective Tissue Disorders Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septic Arthritis Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Medical Back Problems Without 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10396.15,"maximum":19742.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19742.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10396.15,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16675.42,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":35971.04,"10th_percentile":35971.04,"90th_percentile":35971.04,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6788.96,"maximum":12613.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12613.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6788.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10889.49,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7077.05,"10th_percentile":7077.05,"90th_percentile":7077.05,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":169.64,"10th_percentile":169.64,"90th_percentile":169.64,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"555","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10593.45,"maximum":20349.65,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Of Musculoskeletal System And Connective Tissue Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis With Mcc","code_information":[{"code":"557","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11870.9,"maximum":23420.62,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23420.62},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11870.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19040.92,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Tendonitis, Myositis And Bursitis Without 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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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":48567.29,"10th_percentile":48567.29,"90th_percentile":48567.29,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With Mcc","code_information":[{"code":"559","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14795.65,"maximum":28051.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28051.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14795.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23732.22,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare, Musculoskeletal System And Connective Tissue Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh With Mcc","code_information":[{"code":"562","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11390.41,"maximum":22120.9,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22120.9},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11390.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11390.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11390.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18270.22,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fracture, Sprain, Strain And Dislocation Except Femur, Hip, Pelvis And Thigh Without 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9407.17},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9797.69},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7294.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7294.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10423.22},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7294.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":43235.63,"10th_percentile":43235.63,"90th_percentile":43235.63,"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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"15","median_amount":9339.59,"10th_percentile":359.46,"90th_percentile":14952.59,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29579.76,"10th_percentile":29579.76,"90th_percentile":121737.86,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":38099.0,"10th_percentile":38099.0,"90th_percentile":41157.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"24","median_amount":37701.47,"10th_percentile":20178.75,"90th_percentile":85170.27,"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":437.02,"10th_percentile":437.02,"90th_percentile":437.02},{"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":15181.73,"10th_percentile":15181.73,"90th_percentile":15181.73,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11453.29,"10th_percentile":11453.29,"90th_percentile":11453.29,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11897.27,"10th_percentile":11897.27,"90th_percentile":11897.27,"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":"26","median_amount":9551.03,"10th_percentile":356.1,"90th_percentile":17655.42,"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":12558.3,"10th_percentile":12558.3,"90th_percentile":12558.3,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3381.12,"10th_percentile":3381.12,"90th_percentile":3381.12,"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":"1 through 10","median_amount":8052.43,"10th_percentile":8052.43,"90th_percentile":9263.34,"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":6464.97,"10th_percentile":6464.97,"90th_percentile":7493.84,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":22433.98,"10th_percentile":12028.97,"90th_percentile":91045.43,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":45981.45,"10th_percentile":45981.45,"90th_percentile":45981.45,"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":"1 through 10","median_amount":8171.87,"10th_percentile":588.18,"90th_percentile":14942.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":11089.16,"10th_percentile":11089.16,"90th_percentile":11089.16,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses With Cc","code_information":[{"code":"565","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7905.47,"maximum":15409.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15409.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12680.37,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10732.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11177.94},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11891.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12440.14},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12351.43},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7905.47,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":9706.96,"10th_percentile":9706.96,"90th_percentile":10413.95,"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":"1 through 10","median_amount":6849.99,"10th_percentile":6849.99,"90th_percentile":6849.99,"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":"21","median_amount":6941.87,"10th_percentile":256.82,"90th_percentile":10737.69,"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":"1 through 10","median_amount":11371.15,"10th_percentile":11371.15,"90th_percentile":11371.15,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":31082.04,"10th_percentile":27422.0,"90th_percentile":43023.34,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":30352.0,"10th_percentile":21347.0,"90th_percentile":101482.66,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"15","median_amount":37120.79,"10th_percentile":25074.83,"90th_percentile":54066.53,"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":10328.15,"10th_percentile":10328.15,"90th_percentile":10328.15},{"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":6261.94,"10th_percentile":6261.94,"90th_percentile":7539.04,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3650.89,"10th_percentile":3650.89,"90th_percentile":3650.89,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":6652.16,"10th_percentile":365.67,"90th_percentile":9165.32,"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":"1 through 10","median_amount":6956.63,"10th_percentile":6956.63,"90th_percentile":7749.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 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":6993.56,"10th_percentile":267.86,"90th_percentile":9776.75,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Musculoskeletal System And Connective Tissue Diagnoses Without Cc/Mcc","code_information":[{"code":"566","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6163.78,"maximum":11304.52,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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":4702.55,"10th_percentile":4702.55,"90th_percentile":12590.74,"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":"1 through 10","median_amount":10286.48,"10th_percentile":10286.48,"90th_percentile":10286.48,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":74242.52,"10th_percentile":74242.52,"90th_percentile":74242.52,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":248.91,"10th_percentile":248.91,"90th_percentile":248.91,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":49978.94,"10th_percentile":30811.83,"90th_percentile":105075.56,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5958.81,"10th_percentile":988.35,"90th_percentile":14694.49,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":295.22,"10th_percentile":295.22,"90th_percentile":295.22,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":15806.35,"10th_percentile":15806.35,"90th_percentile":15806.35,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7364.72,"10th_percentile":7364.72,"90th_percentile":7364.72,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Mcc","code_information":[{"code":"570","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23122.66,"maximum":45496.18,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement With Cc","code_information":[{"code":"571","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13438.5,"maximum":25311.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25311.25},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13438.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21555.35,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Debridement Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft For Skin Ulcer Or Cellulitis With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections With Mcc","code_information":[{"code":"689","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9343.86,"maximum":17688.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17688.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14987.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":12319.74},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12831.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13650.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14280.05},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14178.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9343.86,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":28759.0,"10th_percentile":28759.0,"90th_percentile":28759.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":31767.36,"10th_percentile":31767.36,"90th_percentile":31767.36,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10783.91,"10th_percentile":10783.91,"90th_percentile":10783.91,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Infections Without Mcc","code_information":[{"code":"690","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6629.57,"maximum":12129.69,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":12129.69},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10633.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":8448.24},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8798.95},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":9360.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9792.52},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9722.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6629.57,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10769.09,"maximum":22220.64,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22220.64},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17273.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15476.51},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16118.99},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17148.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17939.13},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17811.21},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10769.09,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Signs And Symptoms With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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Stricture","code_information":[{"code":"697","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8705.52,"maximum":15140.2,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15140.2},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8705.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13963.65,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses With 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"1 through 10","median_amount":7021.22,"10th_percentile":7021.22,"90th_percentile":7021.22,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":22660.83,"10th_percentile":22660.83,"90th_percentile":46908.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":17998.31,"10th_percentile":17998.31,"90th_percentile":17998.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":388.99,"10th_percentile":289.44,"90th_percentile":954.38,"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":4868.91,"10th_percentile":4868.91,"90th_percentile":4868.91,"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. 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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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":1102.78,"10th_percentile":1102.78,"90th_percentile":1102.78,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Diagnoses Without Cc/Mcc","code_information":[{"code":"700","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5704.18,"maximum":10489.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11207.8,"maximum":22689.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22689.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Testes Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transurethral Prostatectomy With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Male Reproductive System Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":9420.46,"maximum":19089.23,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19089.23},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9420.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15110.42,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5952.55,"maximum":11248.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11248.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5952.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9547.89,"additional_payer_notes":"MSDRG Base 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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":"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inflammation Of The Male Reproductive System With Mcc","code_information":[{"code":"727","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11839.95,"maximum":22205.53,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":46891.95,"10th_percentile":46891.95,"90th_percentile":46891.95,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":32637.83,"10th_percentile":27639.83,"90th_percentile":33560.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Male Reproductive System Diagnoses Without Cc/Mcc","code_information":[{"code":"730","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5565.68,"maximum":9172.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":16846.84,"maximum":31778.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":31778.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":16846.84,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27022.33,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With Mcc","code_information":[{"code":"736","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":28023.54,"maximum":59504.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59504.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28023.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28023.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":28023.54,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44949.76,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Ovarian Or Adnexal Malignancy Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy With 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Ovarian And Non-Adnexal Malignancy Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy With 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":32423.74,"10th_percentile":32423.74,"90th_percentile":32423.74,"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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Uterine And Adnexa Procedures For Non-Malignancy Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":17695.45,"10th_percentile":17695.45,"90th_percentile":17695.45,"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. 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":300.74,"10th_percentile":300.74,"90th_percentile":300.74,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":39771.74,"10th_percentile":39771.74,"90th_percentile":46940.25,"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":11878.7,"10th_percentile":11878.7,"90th_percentile":11878.7},{"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization, Laparoscopy And Tubal Interruption Without 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vagina, Cervix And Vulva Procedures Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11100.25,"maximum":20586.93,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20586.93},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11100.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17804.8,"additional_payer_notes":"MSDRG Base 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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":18001.63,"10th_percentile":11839.81,"90th_percentile":37486.24,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":282513.96,"10th_percentile":282513.96,"90th_percentile":282513.96,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":15092.58,"10th_percentile":15092.58,"90th_percentile":15092.58,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":85633.35,"10th_percentile":85633.35,"90th_percentile":111202.9,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":22930.31,"10th_percentile":22930.31,"90th_percentile":22930.31,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Female Reproductive System O.R. Procedures Without Cc/Mcc","code_information":[{"code":"750","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11785.02,"maximum":19488.21,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19488.21},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18903.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13573.39},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14136.87},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15039.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15733.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15621.0},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11785.02,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System With Mcc","code_information":[{"code":"754","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":14616.14,"maximum":27342.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27342.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14616.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14616.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14616.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23444.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19043.8},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19834.37},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14616.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14616.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":21100.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14616.14,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Infections, Female Reproductive System Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8161.58,"maximum":14893.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14893.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8161.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8161.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8161.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13091.17,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":89604.51,"10th_percentile":89604.51,"90th_percentile":89604.51,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":61273.0,"10th_percentile":61273.0,"90th_percentile":61273.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":12446.26,"10th_percentile":7092.03,"90th_percentile":14997.05,"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":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":53346.79,"10th_percentile":23579.04,"90th_percentile":106247.49,"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":"1 through 10","median_amount":29796.15,"10th_percentile":29796.15,"90th_percentile":29796.15},{"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"36","median_amount":6474.21,"10th_percentile":230.37,"90th_percentile":11692.2,"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":"1 through 10","median_amount":12554.34,"10th_percentile":8619.59,"90th_percentile":14081.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6608.72,"10th_percentile":6608.72,"90th_percentile":8401.7,"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":"1 through 10","median_amount":14513.57,"10th_percentile":14513.57,"90th_percentile":14513.57,"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":"1 through 10","median_amount":311.22,"10th_percentile":311.22,"90th_percentile":311.22,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":11484.8,"10th_percentile":11484.8,"90th_percentile":11484.8,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":7522.25,"10th_percentile":7522.25,"90th_percentile":7522.25,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":6328.5,"10th_percentile":1599.97,"90th_percentile":13889.39,"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":"Wellcare","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":10332.15,"90th_percentile":12231.29,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":4780.33,"maximum":9580.13,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9580.13},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":4780.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":286.76,"10th_percentile":286.76,"90th_percentile":286.76,"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":13012.58,"10th_percentile":13012.58,"90th_percentile":13012.58},{"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":5565.1,"10th_percentile":5565.1,"90th_percentile":5565.1,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6355.31,"10th_percentile":6355.31,"90th_percentile":6355.31,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery 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":8657.55,"maximum":16568.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16568.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13886.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11539.75},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12018.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":12786.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13375.96},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13280.58},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8657.55,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postpartum And Post Abortion Diagnoses With O.R. Procedures","code_information":[{"code":"769","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13440.82,"maximum":21559.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20999.51},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21559.08,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14626.0},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15233.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16205.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16953.29},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16832.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13440.82,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":54118.6,"10th_percentile":54118.6,"90th_percentile":54118.6,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":627.8,"10th_percentile":627.8,"90th_percentile":627.8,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3908.8,"10th_percentile":3908.8,"90th_percentile":3908.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion With D&C, Aspiration Curettage Or Hysterotomy","code_information":[{"code":"770","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8124.44,"maximum":16260.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial 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Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13127.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13033.45},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8124.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8124.44,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8124.44,"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 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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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":5431.82,"maximum":10781.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10781.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8712.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":7509.31},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7821.05},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8320.38},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8704.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8642.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5431.82,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","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. 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2613.8,"10th_percentile":2613.8,"90th_percentile":2621.61,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":13623.78,"10th_percentile":10921.18,"90th_percentile":30794.18,"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":8648.5,"10th_percentile":8648.5,"90th_percentile":8648.5},{"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Abortion Without D&C","code_information":[{"code":"779","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6875.62,"maximum":14126.12,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":14126.12},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12782.0,"10th_percentile":12782.0,"90th_percentile":12782.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":19362.27,"maximum":31057.08,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27838.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19362.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19362.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19362.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":31057.08,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extreme Immaturity Or Respiratory Distress Syndrome, 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"12","median_amount":56289.5,"10th_percentile":29084.0,"90th_percentile":92639.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":32076.0,"10th_percentile":32076.0,"90th_percentile":42768.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Prematurity With Major 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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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":23400.0,"10th_percentile":18384.0,"90th_percentile":57716.45,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services 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10","median_amount":13944.08,"10th_percentile":12576.88,"90th_percentile":31928.99,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"56","median_amount":14586.0,"10th_percentile":9681.58,"90th_percentile":41544.75,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":12060.0,"10th_percentile":12060.0,"90th_percentile":12060.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Term Neonate With Major 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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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25040.0,"10th_percentile":24428.0,"90th_percentile":61022.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":11565.4,"10th_percentile":7922.6,"90th_percentile":44083.55},{"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":9192.0,"10th_percentile":6084.0,"90th_percentile":12006.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services 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16.9]","count":"29","median_amount":12043.08,"10th_percentile":2963.75,"90th_percentile":21692.36,"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":979.37,"10th_percentile":979.37,"90th_percentile":4075.63,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"24","median_amount":14771.31,"10th_percentile":11131.0,"90th_percentile":22243.57,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"33","median_amount":13664.0,"10th_percentile":10556.0,"90th_percentile":25516.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"170","median_amount":13886.0,"10th_percentile":9398.0,"90th_percentile":25511.62,"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":"21","median_amount":5938.8,"10th_percentile":3297.82,"90th_percentile":14134.45},{"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1245.79,"10th_percentile":888.81,"90th_percentile":1372.7,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1372.71,"10th_percentile":1372.71,"90th_percentile":2446.16,"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":"1 through 10","median_amount":998.96,"10th_percentile":998.96,"90th_percentile":998.96,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"43","median_amount":4858.0,"10th_percentile":2446.4,"90th_percentile":7287.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":6271.2,"10th_percentile":4824.0,"90th_percentile":9648.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Normal Newborn","code_information":[{"code":"795","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":1912.07,"maximum":3066.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":3019.58},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1912.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1912.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":1912.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":3066.96,"additional_payer_notes":"MSDRG Base 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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":"17","median_amount":888.83,"10th_percentile":888.83,"90th_percentile":979.37,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"140","median_amount":10843.0,"10th_percentile":6590.54,"90th_percentile":15994.44,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"211","median_amount":10216.0,"10th_percentile":6725.0,"90th_percentile":13768.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9050.52,"10th_percentile":9050.52,"90th_percentile":10926.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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":"298","median_amount":979.37,"10th_percentile":888.82,"90th_percentile":979.37,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"805","median_amount":10335.0,"10th_percentile":6953.0,"90th_percentile":14710.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"98","median_amount":3622.85,"10th_percentile":2433.55,"90th_percentile":4976.38},{"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":979.37,"10th_percentile":888.81,"90th_percentile":1739.51,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":979.37,"10th_percentile":888.82,"90th_percentile":1245.78,"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":"19","median_amount":998.96,"10th_percentile":998.96,"90th_percentile":998.96,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"191","median_amount":3730.0,"10th_percentile":1793.0,"90th_percentile":4443.62,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"28","median_amount":3730.0,"10th_percentile":1865.0,"90th_percentile":5595.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With Mcc","code_information":[{"code":"796","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9395.7,"maximum":19293.26,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19293.26},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15070.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13437.61},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13995.44},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14888.99},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9395.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery With Sterilization And/Or D&C Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Splenic Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery Without Sterilization Or D&C Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Hematological And Immunological Diagnoses Except Sickle Cell Crisis And Coagulation Disorders 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders With 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Without Mcc","code_information":[{"code":"812","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7470.63,"maximum":13947.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13947.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7470.63,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11982.89,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coagulation Disorders","code_information":[{"code":"813","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12168.02,"maximum":23393.41,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23393.41},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12168.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12168.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12168.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19517.5,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia With Other Procedures With 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma 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":10807.01,"maximum":18599.57,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18599.57},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10807.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17334.44,"additional_payer_notes":"MSDRG Base 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Procedures With Mcc","code_information":[{"code":"826","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":36560.24,"maximum":72167.6,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":72167.6},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":58642.62,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":50264.18},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52350.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":55693.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":58262.22},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57846.77},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":36560.24,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":196943.98,"10th_percentile":196943.98,"90th_percentile":196943.98,"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":"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":97891.77,"10th_percentile":37648.56,"90th_percentile":337646.98,"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":32515.32,"10th_percentile":32515.32,"90th_percentile":32515.32},{"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":21340.22,"10th_percentile":21340.22,"90th_percentile":21340.22,"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":"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":68600.6,"10th_percentile":68600.6,"90th_percentile":68600.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12010.95,"maximum":22101.25,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Leukemia With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma And Non-Acute Leukemia Without Cc/Mcc","code_information":[{"code":"842","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8184.02,"maximum":15895.85,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15895.85},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8184.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13127.17,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Mcc","code_information":[{"code":"843","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15800.74,"maximum":28610.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28610.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25344.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":19926.94},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20754.17},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":22079.23},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23097.71},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22933.01},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15800.74,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":19412.23,"10th_percentile":19412.23,"90th_percentile":19412.23,"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":9722.69,"10th_percentile":228.34,"90th_percentile":12559.63,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":34790.87,"10th_percentile":34790.87,"90th_percentile":34790.87,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":53030.02,"10th_percentile":53030.02,"90th_percentile":146933.22,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":9601.88,"10th_percentile":9601.88,"90th_percentile":9601.88,"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":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":29051.83,"10th_percentile":178.71,"90th_percentile":211978.03,"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":"1 through 10","median_amount":2239.0,"10th_percentile":2239.0,"90th_percentile":2239.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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. 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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":7935.53,"10th_percentile":7935.53,"90th_percentile":7935.53,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":24934.64,"10th_percentile":24934.64,"90th_percentile":24934.64,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":25441.53,"10th_percentile":25441.53,"90th_percentile":25441.53,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13026.01,"10th_percentile":10922.96,"90th_percentile":16405.63,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7972.82,"10th_percentile":7972.82,"90th_percentile":7972.82,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Myeloproliferative Disorders Or Poorly Differentiated Neoplastic Diagnoses With Cc","code_information":[{"code":"844","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9785.67,"maximum":18061.55,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18061.55},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9785.67,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":25327.04,"10th_percentile":25327.04,"90th_percentile":34514.8,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":27083.0,"10th_percentile":23194.0,"90th_percentile":46353.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":19598.3,"10th_percentile":13505.83,"90th_percentile":120147.09,"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":"0","additional_payer_notes":"No services performed during 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":6062.54,"10th_percentile":6062.54,"90th_percentile":6062.54,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4271.53,"10th_percentile":4271.53,"90th_percentile":4271.53,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7107.34,"10th_percentile":4734.22,"90th_percentile":7597.18,"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":6004.63,"10th_percentile":6004.63,"90th_percentile":6004.63,"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. 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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":"1 through 10","median_amount":8209.2,"10th_percentile":8209.2,"90th_percentile":8209.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Graft Except For Skin Ulcer Or Cellulitis With 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin 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":12795.52,"maximum":25545.5,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25545.5},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12795.52,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20524.01,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With Mcc","code_information":[{"code":"579","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":25423.77,"maximum":49254.78,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":49254.78},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25423.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25423.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":25423.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":40779.73,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Skin, Subcutaneous Tissue And Breast Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Breast Biopsy, Local Excision And Other Breast Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Ulcers Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Skin Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignant Breast Disorders Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Malignant Breast Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cellulitis Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast With Mcc","code_information":[{"code":"604","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11756.39,"maximum":22453.38,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22453.38},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11756.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18857.25,"additional_payer_notes":"MSDRG Base 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Trauma To The Skin, Subcutaneous Tissue And Breast Without Mcc","code_information":[{"code":"605","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7453.61,"maximum":13959.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13959.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11955.59,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9722.95},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10126.58},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10773.11},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11270.06},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11189.7},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7453.61,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":13101.38,"10th_percentile":13101.38,"90th_percentile":13101.38,"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. 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":27482.27,"10th_percentile":27482.27,"90th_percentile":27482.27,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders With Mcc","code_information":[{"code":"606","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12074.4,"maximum":24333.44,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24333.44},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19367.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16948.06},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17651.62},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18778.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12074.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29575.87,"10th_percentile":29575.87,"90th_percentile":29575.87,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Skin Disorders Without Mcc","code_information":[{"code":"607","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7379.33,"maximum":13062.17,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13062.17},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7379.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11836.45,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Adrenal And Pituitary Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Obesity Without Cc/Mcc","code_information":[{"code":"621","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12037.26,"maximum":22090.67,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22090.67},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19307.77,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15385.99},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16024.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17047.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17834.2},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17707.03},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12037.26,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With Mcc","code_information":[{"code":"622","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":27905.16,"maximum":56583.07,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":56583.07},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":27905.16,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":44759.88,"additional_payer_notes":"MSDRG Base 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts And Wound Debridement For Endocrine, Nutritional And Metabolic Disorders Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":10643.75,"maximum":19145.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19145.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17072.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13334.45},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13888.0},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14774.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10643.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Endocrine, Nutritional And Metabolic 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":96427.0,"10th_percentile":96427.0,"90th_percentile":96427.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Diabetes Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes With 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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":496.97,"10th_percentile":496.97,"90th_percentile":496.97,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":50697.7,"10th_percentile":27283.61,"90th_percentile":130404.78,"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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":12124.54,"10th_percentile":12124.54,"90th_percentile":12124.54,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Miscellaneous Disorders Of Nutrition, Metabolism, Fluids And Electrolytes Without Mcc","code_information":[{"code":"641","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6387.39,"maximum":11810.81,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":11810.81},{"payer_name":"Aetna","plan_name":"Medicare Managed 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":312.3,"10th_percentile":312.3,"90th_percentile":312.3,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":8522.96,"10th_percentile":8522.96,"90th_percentile":10980.78,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":8932.85,"10th_percentile":8932.85,"90th_percentile":8932.85,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7207.17,"10th_percentile":7207.17,"90th_percentile":7207.17,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":11369.52,"maximum":18756.74,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":13102.7,"maximum":25046.77,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25046.77},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13102.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13102.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13102.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21016.73,"additional_payer_notes":"MSDRG Base 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":8296.99,"maximum":15619.29,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15619.29},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8296.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8296.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8296.99,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13308.37,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":4571.08,"10th_percentile":4571.08,"90th_percentile":4571.08,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endocrine Disorders Without Cc/Mcc","code_information":[{"code":"645","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6310.79,"maximum":11773.03,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney Transplant With Hemodialysis With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures With 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Bladder Procedures Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Neoplasm Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm With Cc","code_information":[{"code":"660","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10592.68,"maximum":20249.91,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20249.91},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16990.66,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14103.91},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14689.4},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15627.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16348.12},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16231.55},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10592.68,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":114573.0,"10th_percentile":114573.0,"90th_percentile":114573.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":10382.67,"10th_percentile":10382.67,"90th_percentile":10382.67,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Ureter Procedures For Non-Neoplasm Without Cc/Mcc","code_information":[{"code":"661","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8377.46,"maximum":15515.01,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15515.01},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13437.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10806.08},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11254.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11973.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8377.46,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Minor Bladder Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Urethral Procedures Without 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Kidney And Urinary Tract Procedures With 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":24297.37},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25306.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":26921.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":28163.57},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":27962.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":18460.86,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-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":144.65,"10th_percentile":144.65,"90th_percentile":144.65,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":17595.72,"10th_percentile":17595.72,"90th_percentile":17595.72,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":175.14,"10th_percentile":175.14,"90th_percentile":175.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Other Kidney And Urinary Tract Procedures Without Cc/Mcc","code_information":[{"code":"675","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13066.33,"maximum":23654.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23654.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20958.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16475.44},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17159.38},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":18254.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19097.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18960.83},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13066.33,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Mcc","code_information":[{"code":"682","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11825.25,"maximum":22699.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22699.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18967.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15810.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16466.52},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17517.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18325.9},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18195.23},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11825.25,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5738.06,"10th_percentile":5738.06,"90th_percentile":6186.98,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":310.92,"10th_percentile":310.92,"90th_percentile":10325.21,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure With Cc","code_information":[{"code":"683","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7142.56,"maximum":13433.95,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13433.95},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11456.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9356.64},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9745.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10367.24},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10845.47},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10768.13},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7142.56,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":9175.07,"10th_percentile":9175.07,"90th_percentile":9175.07,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3832.62,"10th_percentile":3832.62,"90th_percentile":3832.62,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Renal Failure Without Cc/Mcc","code_information":[{"code":"684","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5010.9,"maximum":9181.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":9181.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8037.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":6394.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6660.06},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":7085.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7412.11},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7359.26},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5010.9,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 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":6305.47,"10th_percentile":6305.47,"90th_percentile":6305.47,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Kidney And Urinary Tract Neoplasms Without Cc/Mcc","code_information":[{"code":"688","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6481.01,"maximum":10944.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10944.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6481.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10395.54,"additional_payer_notes":"MSDRG Base 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Procedures With Mcc","code_information":[{"code":"856","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":35561.34,"maximum":68179.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":68179.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":57040.39,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":47486.35},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49457.65},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":52615.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":55042.37},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":54649.89},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":35561.34,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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Procedures Without Cc/Mcc","code_information":[{"code":"858","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11143.58,"maximum":19471.59,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19471.59},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17874.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13561.81},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14124.81},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":15026.61},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15719.77},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15607.68},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11143.58,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":14476.86,"maximum":27786.76,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":27786.76},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":14476.86,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":23220.88,"additional_payer_notes":"MSDRG Base 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":16263.72,"10th_percentile":16263.72,"90th_percentile":16263.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13292.33,"10th_percentile":13292.33,"90th_percentile":13292.33,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Postoperative And Post-Traumatic Infections Without 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10525.04},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10961.96},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":11661.83},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8087.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":49143.86,"10th_percentile":49143.86,"90th_percentile":49143.86,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Fever And Inflammatory Conditions","code_information":[{"code":"864","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7234.64,"maximum":13569.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13569.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7234.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7234.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7234.64,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11604.36,"additional_payer_notes":"MSDRG Base 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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":"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Viral Illness With Mcc","code_information":[{"code":"865","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":11959.11,"maximum":22305.28,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":22305.28},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":11959.11,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19182.41,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Infectious And Parasitic Diseases Diagnoses Without Cc/Mcc","code_information":[{"code":"869","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":6012.13,"maximum":10873.8,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10873.8},{"payer_name":"Aetna","plan_name":"Medicare Managed Care 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schedule","standard_charge_dollar":6012.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":8391.53},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6012.13,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee 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16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis With Mv >96 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours With Mcc","code_information":[{"code":"871","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15396.07,"maximum":29656.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":29656.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15396.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24695.3,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":40082.02,"10th_percentile":40082.02,"90th_percentile":40082.02,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Septicemia Or Severe Sepsis Without Mv >96 Hours Without 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9226.68,"10th_percentile":9226.68,"90th_percentile":9226.68,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. Procedures With Principal Diagnosis Of Mental Illness","code_information":[{"code":"876","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":30270.49,"maximum":59385.02,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":59385.02},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":48553.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":41361.22},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43078.25},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":45828.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":47942.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":47600.75},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":30270.49,"additional_payer_notes":"MSDRG Base Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Adjustment Reaction And Psychosocial 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Depressive Neuroses","code_information":[{"code":"881","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7646.27,"maximum":13814.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13814.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7646.27,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12264.62,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neuroses Except 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Disorders Of Personality And Impulse 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Organic Disturbances And Intellectual 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":14900.77,"10th_percentile":14900.77,"90th_percentile":14900.77,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Behavioral And Developmental 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence With Rehabilitation 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy With 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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. 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Alcohol, Drug Abuse Or Dependence Without Rehabilitation Therapy Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Wound Debridements For Injuries Without 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Skin Grafts For Injuries Without 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":15564.75,"maximum":32982.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32982.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15564.75,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24965.86,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries With Cc","code_information":[{"code":"908","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":15803.83,"maximum":30482.92,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":30482.92},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":25349.34,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":21231.12},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22112.49},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":23524.27},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24609.42},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":24433.94},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":15803.83,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":92419.31,"10th_percentile":92419.31,"90th_percentile":92419.31,"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":"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other O.R. Procedures For Injuries Without Cc/Mcc","code_information":[{"code":"909","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10523.04,"maximum":19166.31,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19166.31},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16878.96,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13349.19},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13903.35},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14791.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15473.31},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15362.97},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10523.04,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury With Mcc","code_information":[{"code":"913","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13013.72,"maximum":24455.86,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24455.86},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13013.72,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20874.01,"additional_payer_notes":"MSDRG Base 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Traumatic Injury Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Allergic Reactions Without 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":12501.5,"maximum":24779.27,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":24779.27},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20052.41,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17258.58},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17975.03},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19122.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20004.76},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19862.11},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12501.5,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":12251.86,"10th_percentile":12251.86,"90th_percentile":12251.86,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9910.38,"10th_percentile":9910.38,"90th_percentile":9910.38,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":6997.87,"maximum":13365.94,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13365.94},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11224.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":9309.27},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":9695.73},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":10314.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":10790.56},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":10713.62},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":6997.87,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":43376.31,"10th_percentile":43376.31,"90th_percentile":43376.31,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14416.79,"10th_percentile":14416.79,"90th_percentile":14416.79,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications Of Treatment With Cc","code_information":[{"code":"920","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":8121.35,"maximum":15351.79,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15351.79},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":13026.65,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":10692.4},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11136.28},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":8121.35,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Injury, Poisoning And Toxic Effect Diagnoses With Mcc","code_information":[{"code":"922","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13901.97,"maximum":25528.88,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25528.88},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13901.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13901.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13901.97,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":22298.76,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours With Skin 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury With 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Full Thickness Burn With Skin Graft Or Inhalation Injury Without 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive Burns Or Full Thickness Burns With Mv >96 Hours Without Skin 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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":17470.47,"maximum":32427.96,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32427.96},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17470.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17470.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17470.47,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28022.63,"additional_payer_notes":"MSDRG Base 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":30720.54,"10th_percentile":8623.4,"90th_percentile":100473.77,"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":"46","median_amount":21667.61,"10th_percentile":8128.73,"90th_percentile":38087.26,"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":"1 through 10","median_amount":36081.45,"10th_percentile":36081.45,"90th_percentile":36141.81,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"44","median_amount":81899.04,"10th_percentile":27536.0,"90th_percentile":202126.7,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"50","median_amount":71071.92,"10th_percentile":26107.0,"90th_percentile":213678.64,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":34251.47,"10th_percentile":21322.0,"90th_percentile":39518.25,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"213","median_amount":76496.51,"10th_percentile":27671.0,"90th_percentile":183602.62,"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":"30","median_amount":18549.76,"10th_percentile":500.0,"90th_percentile":75195.05},{"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":15145.33,"10th_percentile":15145.33,"90th_percentile":15145.33,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":14095.64,"10th_percentile":4866.33,"90th_percentile":36190.63,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":22003.9,"10th_percentile":22003.9,"90th_percentile":22003.9,"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":"1 through 10","median_amount":31326.37,"10th_percentile":31326.37,"90th_percentile":31326.37,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"135","median_amount":20548.86,"10th_percentile":11996.6,"90th_percentile":37621.49,"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":27022.38,"10th_percentile":16043.47,"90th_percentile":34884.06,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":16266.45,"10th_percentile":10860.07,"90th_percentile":31098.26,"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":12303.28,"10th_percentile":12303.28,"90th_percentile":12303.28,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":14573.19,"10th_percentile":8795.88,"90th_percentile":60713.07,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":254.34,"10th_percentile":254.34,"90th_percentile":254.34,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"49","median_amount":24027.77,"10th_percentile":8873.69,"90th_percentile":60999.91,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"11","median_amount":34486.14,"10th_percentile":9866.53,"90th_percentile":59621.47,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"69","median_amount":22180.49,"10th_percentile":11778.47,"90th_percentile":37514.06,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":24617.31,"10th_percentile":241.18,"90th_percentile":35545.38,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32904.77,"10th_percentile":32904.77,"90th_percentile":32904.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":"0","additional_payer_notes":"No services performed during 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":10372.48,"10th_percentile":10372.48,"90th_percentile":10372.48,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":97738.0,"10th_percentile":97738.0,"90th_percentile":201763.08,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29929.16,"10th_percentile":29929.16,"90th_percentile":29929.16,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":67470.52,"10th_percentile":32798.17,"90th_percentile":84441.8,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9537.97,"10th_percentile":9537.97,"90th_percentile":12945.32,"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":"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":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":20089.86,"10th_percentile":20089.86,"90th_percentile":20089.86,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":15422.48,"10th_percentile":15422.48,"90th_percentile":15422.48,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7507.08,"10th_percentile":5052.26,"90th_percentile":25116.52,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"90","median_amount":15515.53,"10th_percentile":8150.44,"90th_percentile":31848.52,"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":"1 through 10","median_amount":18461.54,"10th_percentile":18461.54,"90th_percentile":18461.54,"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] [MSDRG Base Rate: FEE SCHEDULE]","count":"91","median_amount":57383.07,"10th_percentile":22784.47,"90th_percentile":136407.06,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"117","median_amount":56357.0,"10th_percentile":26653.0,"90th_percentile":185133.14,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":19496.52,"10th_percentile":12733.18,"90th_percentile":21823.26,"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":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"473","median_amount":51735.97,"10th_percentile":25379.0,"90th_percentile":146840.19,"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":"69","median_amount":20748.43,"10th_percentile":8175.65,"90th_percentile":43650.36},{"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":14453.68,"10th_percentile":3708.45,"90th_percentile":29313.29,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":7481.11,"10th_percentile":5977.44,"90th_percentile":12641.77,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14166.66,"10th_percentile":14166.66,"90th_percentile":14166.66,"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":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"190","median_amount":16990.81,"10th_percentile":8228.32,"90th_percentile":30729.99,"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":"1 through 10","median_amount":28853.52,"10th_percentile":19891.7,"90th_percentile":44303.71,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":6279.09,"10th_percentile":3168.22,"90th_percentile":14529.29,"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":"1 through 10","median_amount":17801.5,"10th_percentile":17801.5,"90th_percentile":17801.5,"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":"1 through 10","median_amount":11888.09,"10th_percentile":11056.18,"90th_percentile":23093.55,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"92","median_amount":12525.55,"10th_percentile":7733.0,"90th_percentile":33716.92,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"23","median_amount":20613.72,"10th_percentile":7677.0,"90th_percentile":33254.91,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"86","median_amount":15932.06,"10th_percentile":10314.15,"90th_percentile":28719.1,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13938.99,"10th_percentile":13938.99,"90th_percentile":16421.33,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":12649.32,"10th_percentile":175.14,"90th_percentile":25664.95,"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."}]}]},{"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":"11","median_amount":3709.54,"10th_percentile":2875.3,"90th_percentile":5362.12,"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":"35","median_amount":22596.34,"10th_percentile":8883.83,"90th_percentile":41049.94,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"113","median_amount":31559.0,"10th_percentile":19264.86,"90th_percentile":81456.24,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"146","median_amount":30532.56,"10th_percentile":18393.0,"90th_percentile":98009.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"169","median_amount":5190.53,"10th_percentile":3066.83,"90th_percentile":6918.82,"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":"12","median_amount":14315.34,"10th_percentile":12581.36,"90th_percentile":23200.31,"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":30465.16,"10th_percentile":30465.16,"90th_percentile":40644.59,"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":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"570","median_amount":28937.7,"10th_percentile":20001.0,"90th_percentile":79635.01,"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":"78","median_amount":9435.16,"10th_percentile":6828.15,"90th_percentile":23978.62},{"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":30664.59,"10th_percentile":30294.89,"90th_percentile":40976.51,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5362.12,"10th_percentile":3168.22,"90th_percentile":6279.09,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"50","median_amount":14796.9,"10th_percentile":9748.31,"90th_percentile":41065.59,"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":26768.73,"10th_percentile":26768.73,"90th_percentile":26768.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4866.33,"10th_percentile":3168.22,"90th_percentile":20755.34,"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":"1 through 10","median_amount":5058.73,"10th_percentile":3231.58,"90th_percentile":20207.72,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"127","median_amount":7733.0,"10th_percentile":6186.4,"90th_percentile":22365.65,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"19","median_amount":9457.25,"10th_percentile":7231.74,"90th_percentile":28678.68,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"29","median_amount":14889.8,"10th_percentile":8784.97,"90th_percentile":41728.47,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13313.29,"10th_percentile":13313.29,"90th_percentile":13313.29,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation With Cc/Mcc","code_information":[{"code":"945","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":12348.3,"maximum":23068.48,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":23068.48},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":19806.67,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":16067.02},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16734.01},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":17802.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":18623.61},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18490.81},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":12348.3,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Rehabilitation Without Cc/Mcc","code_information":[{"code":"946","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":9239.4,"maximum":16872.15,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":16872.15},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14820.0,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":11751.33},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12239.16},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":13020.57},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":9239.4,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms With Mcc","code_information":[{"code":"947","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10188.01,"maximum":19436.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":19436.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16341.57,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":13537.6},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":14099.59},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":14999.78},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15691.71},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15579.82},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10188.01,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":75825.68,"10th_percentile":75825.68,"90th_percentile":75825.68,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":70041.72,"10th_percentile":70041.72,"90th_percentile":70041.72,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":508.15,"10th_percentile":508.15,"90th_percentile":508.15,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Signs And Symptoms Without 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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":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Aftercare With 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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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"39","median_amount":29330.39,"10th_percentile":7566.0,"90th_percentile":72010.55,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"36","median_amount":42444.0,"10th_percentile":17085.0,"90th_percentile":109350.36,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":8070.98,"10th_percentile":6608.15,"90th_percentile":15010.62,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"192","median_amount":34093.95,"10th_percentile":14742.94,"90th_percentile":123231.49,"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":"15","median_amount":9902.2,"10th_percentile":7637.8,"90th_percentile":18411.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"13","median_amount":329.38,"10th_percentile":175.14,"90th_percentile":9201.03,"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":"[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":4574.38,"10th_percentile":3477.83,"90th_percentile":9664.61,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13678.87,"10th_percentile":13678.87,"90th_percentile":13678.87,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"205","median_amount":7305.02,"10th_percentile":265.77,"90th_percentile":13953.59,"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":"11","median_amount":4287.96,"10th_percentile":147.79,"90th_percentile":7966.97,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"12","median_amount":5282.55,"10th_percentile":482.04,"90th_percentile":13783.81,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6750.7,"10th_percentile":6750.7,"90th_percentile":12808.08,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"32","median_amount":10845.47,"10th_percentile":6186.4,"90th_percentile":21596.89,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":21140.14,"10th_percentile":21140.14,"90th_percentile":21573.82,"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":"[MSDRG Base Rate: FEE SCHEDULE]","count":"97","median_amount":7571.56,"10th_percentile":476.33,"90th_percentile":12689.74,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":9283.59,"10th_percentile":6618.38,"90th_percentile":14033.29,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":6551.71,"10th_percentile":248.91,"90th_percentile":17397.82,"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":"Aftercare Without Cc/Mcc","code_information":[{"code":"950","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":5222.91,"maximum":8857.73,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":8857.73},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":8377.55,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":6169.34},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":6425.45},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":6835.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":7151.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":7100.02},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":5222.91,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"15","median_amount":9036.01,"10th_percentile":8193.05,"90th_percentile":10172.39,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":22959.0,"10th_percentile":18909.0,"90th_percentile":26401.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"22","median_amount":22946.0,"10th_percentile":15231.81,"90th_percentile":33061.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"78","median_amount":23262.15,"10th_percentile":14198.54,"90th_percentile":34973.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in 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":5407.5,"10th_percentile":4896.15,"90th_percentile":7942.2},{"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":9622.78,"10th_percentile":9622.78,"90th_percentile":9622.78,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4459.77,"10th_percentile":3832.16,"90th_percentile":118329.25,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":593.67,"10th_percentile":356.1,"90th_percentile":5862.42,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3168.22,"10th_percentile":3168.22,"90th_percentile":3168.22,"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":"1 through 10","median_amount":3231.58,"10th_percentile":3231.58,"90th_percentile":3908.8,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"23","median_amount":7733.0,"10th_percentile":5725.12,"90th_percentile":7733.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":6927.0,"10th_percentile":6927.0,"90th_percentile":7677.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":5049.18,"10th_percentile":249.99,"90th_percentile":6933.72,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Factors Influencing Health Status","code_information":[{"code":"951","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":4668.14,"maximum":8567.56,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee 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[MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"224","median_amount":9885.94,"10th_percentile":3895.0,"90th_percentile":20609.91,"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":"94","median_amount":4520.56,"10th_percentile":348.36,"90th_percentile":9948.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"362","median_amount":7085.65,"10th_percentile":192.03,"90th_percentile":13507.3,"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":"19","median_amount":7522.15,"10th_percentile":147.79,"90th_percentile":13432.3,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"254","median_amount":28663.0,"10th_percentile":14810.0,"90th_percentile":79195.38,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"361","median_amount":27063.0,"10th_percentile":13316.0,"90th_percentile":72074.94,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":36321.66,"10th_percentile":36321.66,"90th_percentile":78921.78,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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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":"53","median_amount":9811.64,"10th_percentile":183.05,"90th_percentile":15125.93,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1345","median_amount":27642.0,"10th_percentile":12774.0,"90th_percentile":70052.84,"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":"159","median_amount":8802.85,"10th_percentile":4776.8,"90th_percentile":26160.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"53","median_amount":7092.34,"10th_percentile":214.91,"90th_percentile":14085.35,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient 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":4489.24,"10th_percentile":2515.19,"90th_percentile":8147.75,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":7876.23,"10th_percentile":7876.23,"90th_percentile":7876.23,"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":"1 through 10","median_amount":8193.52,"10th_percentile":6745.44,"90th_percentile":10938.44,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"834","median_amount":7904.14,"10th_percentile":301.14,"90th_percentile":14607.05,"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":"45","median_amount":7613.46,"10th_percentile":2964.2,"90th_percentile":14010.91,"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. 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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":"87","median_amount":3994.59,"10th_percentile":352.9,"90th_percentile":11086.45,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"11","median_amount":12829.23,"10th_percentile":6658.8,"90th_percentile":15485.56,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":13457.4,"10th_percentile":7329.12,"90th_percentile":13852.41,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"258","median_amount":7733.0,"10th_percentile":3985.6,"90th_percentile":17802.73,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"45","median_amount":9226.06,"10th_percentile":3730.0,"90th_percentile":19432.07,"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":"420","median_amount":8172.6,"10th_percentile":477.47,"90th_percentile":15084.62,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"17","median_amount":8102.52,"10th_percentile":1481.71,"90th_percentile":12855.47,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"19","median_amount":10002.19,"10th_percentile":220.43,"90th_percentile":14010.03,"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":"Craniotomy For Multiple Significant Trauma","code_information":[{"code":"955","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":52447.48,"maximum":103190.05,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":103190.05},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":84125.76,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":71871.09},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":74854.68},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":79633.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":83307.21},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":82713.18},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":52447.48,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Limb Reattachment, Hip And Femur Procedures For Multiple Significant 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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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Procedures For Multiple Significant Trauma With Cc","code_information":[{"code":"958","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":32970.85,"maximum":62106.87,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":62106.87},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":52885.24,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":43256.97},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":45052.7},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":47929.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":50140.01},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":49782.48},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":32970.85,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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Procedures For Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"959","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":23145.87,"maximum":39954.24,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":39954.24},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":37125.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":27827.82},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28983.04},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":30833.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":32255.78},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":32025.78},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":23145.87,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With 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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma With 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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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Multiple Significant Trauma Without Cc/Mcc","code_information":[{"code":"965","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7643.17,"maximum":13790.61,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":13790.61},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7643.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7643.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7643.17,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":12259.64,"additional_payer_notes":"MSDRG Base 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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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Mcc","code_information":[{"code":"974","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":22696.33,"maximum":45127.42,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":45127.42},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36404.91,"additional_payer_notes":"MSDRG Base 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Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":36432.19},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":36172.4},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":22696.33,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition With Cc","code_information":[{"code":"975","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":10386.09,"maximum":21480.11,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":21480.11},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":16659.29,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":14960.73},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15581.8},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16576.62},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":17341.28},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":17217.63},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10386.09,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Major Related Condition Without Cc/Mcc","code_information":[{"code":"976","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":7350.7,"maximum":15156.83,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":15156.83},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":7350.7,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":11790.52,"additional_payer_notes":"MSDRG Base 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hiv With Or Without Other Related 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Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":15176.52},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":15806.54},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":16815.71},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":10406.98,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee 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Rate"}]},{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Extensive O.R. 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The allowed amount provided accounts for the structural rates, 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":25706.36,"10th_percentile":14055.52,"90th_percentile":38664.59,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":314943.22,"10th_percentile":314943.22,"90th_percentile":314943.22,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":479939.0,"10th_percentile":479939.0,"90th_percentile":479939.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":97715.49,"10th_percentile":441.87,"90th_percentile":131031.68,"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":34578.24,"10th_percentile":34578.24,"90th_percentile":34578.24},{"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":"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14960.39,"10th_percentile":14960.39,"90th_percentile":14960.39,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":20444.88,"10th_percentile":20444.88,"90th_percentile":20444.88,"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":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":32201.14,"10th_percentile":32201.14,"90th_percentile":32201.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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":23190.71,"10th_percentile":19736.6,"90th_percentile":61813.11,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":192898.08,"10th_percentile":192898.08,"90th_percentile":192898.08,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":83140.34,"10th_percentile":75850.86,"90th_percentile":98775.2,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10622.01,"10th_percentile":6918.82,"90th_percentile":30821.13,"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":14843.93,"10th_percentile":14843.93,"90th_percentile":14843.93,"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":20836.32,"10th_percentile":20836.32,"90th_percentile":20836.32,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"14","median_amount":155969.91,"10th_percentile":43696.85,"90th_percentile":242655.4,"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":"1 through 10","median_amount":16179.94,"10th_percentile":16179.94,"90th_percentile":16179.94,"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":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 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":20273.17,"10th_percentile":12641.13,"90th_percentile":38973.25,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15084.62,"10th_percentile":15084.62,"90th_percentile":15084.62,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":24610.64,"10th_percentile":24610.64,"90th_percentile":82466.83,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"1 through 10","median_amount":31590.05,"10th_percentile":31590.05,"90th_percentile":31590.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23193.96,"10th_percentile":11504.55,"90th_percentile":52865.97,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":14177.21,"10th_percentile":14177.21,"90th_percentile":14177.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Extensive O.R. Procedures Unrelated To Principal Diagnosis Without Cc/Mcc","code_information":[{"code":"983","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","minimum":13628.07,"maximum":25210.0,"payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":25210.0},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":21859.42,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"HMO","methodology":"fee schedule","standard_charge_dollar":17558.57},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":18287.48},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"PPO","methodology":"fee schedule","standard_charge_dollar":19455.05},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"fee schedule","standard_charge_dollar":20352.49},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":20207.36},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":13628.07,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"1 through 10","median_amount":13653.72,"10th_percentile":13653.72,"90th_percentile":13653.72,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":62145.19,"10th_percentile":62145.19,"90th_percentile":62145.19,"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 * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":82571.77,"10th_percentile":55060.91,"90th_percentile":89017.28,"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 * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":21472.91,"10th_percentile":21472.91,"90th_percentile":21472.91,"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":"1 through 10","median_amount":14309.17,"10th_percentile":14309.17,"90th_percentile":14309.17,"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":22947.77,"10th_percentile":22947.77,"90th_percentile":22947.77,"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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"1 through 10","median_amount":51510.41,"10th_percentile":51510.41,"90th_percentile":51510.41,"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":37534.11,"10th_percentile":37534.11,"90th_percentile":37534.11},{"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":18049.4,"10th_percentile":18049.4,"90th_percentile":18049.4,"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":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":23526.21,"10th_percentile":13287.8,"90th_percentile":29316.89,"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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":300.74,"10th_percentile":300.74,"90th_percentile":300.74,"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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"1 through 10","median_amount":50764.7,"10th_percentile":50764.7,"90th_percentile":50764.7,"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":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":29308.52,"10th_percentile":29308.52,"90th_percentile":29308.52,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Non-Extensive O.R. 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The allowed amount provided accounts for the structural rates, 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":24490.37,"10th_percentile":24490.37,"90th_percentile":24490.37,"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":"[Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"1 through 10","median_amount":128268.0,"10th_percentile":128268.0,"90th_percentile":128268.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute Major Eye Infections","code_information":[{"code":"044","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Neurological eye disorders","code_information":[{"code":"045","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w CC","code_information":[{"code":"046","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age >17 w/o CC","code_information":[{"code":"047","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Disorders of the Eye Age 0-17","code_information":[{"code":"048","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures","code_information":[{"code":"049","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Sialoadenectomy","code_information":[{"code":"050","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Salivary Gland Procedures Except Sialoadenectomy","code_information":[{"code":"051","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w Cardiac Cath","code_information":[{"code":"104","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Valve & Oth Major Cardiothoracic Proc w/o Cardiac Cath","code_information":[{"code":"105","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Coronary Bypass w PTCA","code_information":[{"code":"106","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"107","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Cardiothoracic Procedures","code_information":[{"code":"108","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w CC","code_information":[{"code":"110","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Cardiovascular Procedures w/o CC","code_information":[{"code":"111","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"112","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac Pacemaker Device Replacement","code_information":[{"code":"118","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vein ligation & 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other circulatory system O.R. procedures","code_information":[{"code":"120","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Acute & Subacute Endocarditis","code_information":[{"code":"126","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Heart Failure & Shock","code_information":[{"code":"127","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Head & Neck Procedures 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cranial/Facial Procedures W/O Cc/Mcc","code_information":[{"code":"132","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W Cc/Mcc","code_information":[{"code":"133","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Ear, Nose, Mouth & Throat O.R. Procedures W/O Cc/Mcc","code_information":[{"code":"134","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Hernia Procedures Except Inguinal & Femoral Age >17 w/o CC","code_information":[{"code":"160","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w CC","code_information":[{"code":"161","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inguinal & Femoral Hernia Procedures Age >17 w/o CC","code_information":[{"code":"162","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Mouth Procedures w/o CC","code_information":[{"code":"169","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Digestive System O.R. Procedures 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complex Aortic Arch Procedures","code_information":[{"code":"209","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":87944.45,"maximum":141062.90,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":141062.9,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":87944.45,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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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[Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":44522.82,"maximum":71414.60,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Cardiac 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other cardiothoracic procedures w/o CC/MCC","code_information":[{"code":"230","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w MCC","code_information":[{"code":"237","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major cardiovasc procedures w/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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous Cardiovascular Procedures With 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19107.71,"maximum":30648.77,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. 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Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Percutaneous 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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 * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":26972.02,"maximum":43263.12,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":43263.12,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":26972.02,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]},{"setting":"inpatient","billing_class":"facility","minimum":19046.58,"maximum":30550.71,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Ascension","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":30550.71,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"additional_payer_notes":"MSDRG Base Rate"},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":19046.58,"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Endoscopic Tubal Interruption","code_information":[{"code":"362","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization & 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"D&C, Conization 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, female reproductive system w CC","code_information":[{"code":"366","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Malignancy, Female Reproductive System w/o CC","code_information":[{"code":"367","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Red Blood Cell Disorders Age 0-17","code_information":[{"code":"396","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w other O.R. proc w CC","code_information":[{"code":"401","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & non-acute leukemia w CC","code_information":[{"code":"403","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Lymphoma & Non-Acute Leukemia w/o CC","code_information":[{"code":"404","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Childhood Mental Disorders","code_information":[{"code":"431","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Complications of treatment w CC","code_information":[{"code":"452","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major joint & limb reattachment proc of upper extremity w/o CC/MCC","code_information":[{"code":"484","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w CC/MCC or disc device/neurostim","code_information":[{"code":"490","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Back & neck proc exc spinal fusion w/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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Transient ischemia","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"526","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"No Longer Valid","code_information":[{"code":"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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Intracranial 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w CC","code_information":[{"code":"531","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Spinal Procedures w/o CC","code_information":[{"code":"532","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal Proc Age > 17 w CC w Major Gi Dx","code_information":[{"code":"567","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Stomach, Esophageal & Duodenal 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Major Small & Large Bowel Procedures w CC w Major Gi Dx","code_information":[{"code":"569","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Admit For Renal Dialysis","code_information":[{"code":"685","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W Complicating Diagnoses","code_information":[{"code":"774","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Vaginal Delivery W/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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W 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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Other Antepartum Diagnoses W/O Medical Complications","code_information":[{"code":"782","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback 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":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","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 > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Principal Diagnosis Invalid As Discharge Diagnosis","code_information":[{"code":"998","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ungroupable","code_information":[{"code":"999","type":"MS-DRG"}],"standard_charges":[{"setting":"inpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > 110960 | Excess % of Charge: 55] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [IP High Cost Drugs (%BC): 13.2] [IP Prosthetics/Implants/Devices (%BC): 16.9]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_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] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.54 | Excess % of Charge: 36.66] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.37 | Excess % of Charge: 34.88] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Stop Loss: Total Charges > BasePayment * 7.84 | Excess % of Charge: 37.11] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Per Diem: 3799] [Normal Vaginal Delivery-Per Diem: 3388]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Countycare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Inpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2262] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10942] [Normal Vaginal Delivery-Case Rate: 7733] [Normal Newborn-Per Diem: 1878] [Lower Level Neonate-Per Diem: 2429] [Higher Level Neonate-Per Diem: 3064] [Severe Level Neonate-per diem: 3590] [Rehab-Per Diem: 1450] [SNF-Per Diem: 997] [Hospice-Per Diem: 997]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Stop Loss: Length of Stay > 20 days | Excess % of Charge: 2245] [Lesser Than Charges paid at %: 100] [MSDRG Base Rate: FEE SCHEDULE] [C-Section-Case Rate: 10864] [Normal Vaginal Delivery-Case Rate: 7677] [Normal Newborn-Per Diem: 1865] [Lower Level Neonate-Per Diem: 2412] [Higher Level Neonate-Per Diem: 3042] [Severe Level Neonate-per diem: 3564] [Rehab-Per Diem: 1439] [SNF-Per Diem: 990] [Hospice-Per Diem: 990]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[MSDRG Base Rate: FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"0764","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9893.05,"10th_percentile":8401.49,"90th_percentile":19176.16,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4686.41,"10th_percentile":4686.41,"90th_percentile":4686.41,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10641.09,"10th_percentile":10641.09,"90th_percentile":10641.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":42962.13,"10th_percentile":31557.18,"90th_percentile":251796.61,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":64138.64,"10th_percentile":33005.14,"90th_percentile":103922.46,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":6400.06,"10th_percentile":214.36,"90th_percentile":20283.67,"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":"1 through 10","median_amount":7562.43,"10th_percentile":7562.43,"90th_percentile":7562.43,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"38","median_amount":44392.01,"10th_percentile":27848.95,"90th_percentile":88296.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":10580.76,"10th_percentile":1694.7,"90th_percentile":42880.04},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1941.64,"10th_percentile":1941.64,"90th_percentile":7181.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12874.05,"10th_percentile":12874.05,"90th_percentile":14199.77,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7528.0,"10th_percentile":4657.6,"90th_percentile":25774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":19899.54,"10th_percentile":19899.54,"90th_percentile":19899.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10643.71,"10th_percentile":10643.71,"90th_percentile":10643.71,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred acetate 1 mg","code_information":[{"code":"0790","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":51.26,"10th_percentile":51.26,"90th_percentile":51.26,"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":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":755.9,"10th_percentile":755.9,"90th_percentile":755.9,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":1877.0,"10th_percentile":1877.0,"90th_percentile":2454.4,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":864.25,"10th_percentile":829.75,"90th_percentile":1327.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":1528.05,"10th_percentile":1528.05,"90th_percentile":3587.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, glycopyrrolate, 0.1 mg","code_information":[{"code":"0792","type":"APC"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","payers_information":[{"payer_name":"Aetna","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":6856.23,"10th_percentile":6578.47,"90th_percentile":8323.56,"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":7792.41,"10th_percentile":7792.41,"90th_percentile":7792.41,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1937.91,"10th_percentile":1570.41,"90th_percentile":1947.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10952.42,"10th_percentile":10843.99,"90th_percentile":68846.58,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":12229.39,"10th_percentile":6290.11,"90th_percentile":48648.68,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":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":"1 through 10","median_amount":808.13,"10th_percentile":808.13,"90th_percentile":808.13,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3820.96,"10th_percentile":3820.96,"90th_percentile":3820.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"27","median_amount":6729.11,"10th_percentile":6071.11,"90th_percentile":11820.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2049.95,"10th_percentile":1380.44,"90th_percentile":14788.64},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1915.16,"10th_percentile":1915.16,"90th_percentile":1915.16,"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":"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":14722.28,"10th_percentile":14722.28,"90th_percentile":14722.28,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5478.1,"10th_percentile":5478.1,"90th_percentile":5478.1,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":1423.47,"10th_percentile":931.37,"90th_percentile":1940.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4164.0,"10th_percentile":4164.0,"90th_percentile":7530.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1946.12,"10th_percentile":1946.12,"90th_percentile":1946.12,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj glycopyrrolate fres kabi","code_information":[{"code":"0793","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":58841.3,"10th_percentile":58841.3,"90th_percentile":58841.3,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":23128.2,"10th_percentile":23128.2,"90th_percentile":23128.2,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":14809.2,"10th_percentile":14809.2,"90th_percentile":14809.2,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":25456.25,"10th_percentile":25456.25,"90th_percentile":26751.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4255.65,"10th_percentile":4255.65,"90th_percentile":4255.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5962.67,"10th_percentile":5962.67,"90th_percentile":5962.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, bumetanide, 0.5 mg","code_information":[{"code":"0794","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":106.78,"10th_percentile":106.78,"90th_percentile":106.78,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Inj, methylpred sod succ 5mg","code_information":[{"code":"0801","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":4649.83,"10th_percentile":4649.83,"90th_percentile":4649.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Injection,onabotulinumtoxinA","code_information":[{"code":"0902","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":969.15,"10th_percentile":969.15,"90th_percentile":969.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13413.74,"10th_percentile":13413.74,"90th_percentile":13413.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Humate-P, inj","code_information":[{"code":"1704","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":14936.11,"10th_percentile":14936.11,"90th_percentile":14936.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Penicillin g benzathine inj","code_information":[{"code":"1829","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":869.16,"10th_percentile":869.16,"90th_percentile":869.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":97231.58,"10th_percentile":97231.58,"90th_percentile":97231.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27501.87,"10th_percentile":27501.87,"90th_percentile":27501.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":100964.29,"10th_percentile":100964.29,"90th_percentile":106270.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28720.61,"10th_percentile":28573.61,"90th_percentile":28720.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Brachytx, non-stranded,P-103","code_information":[{"code":"2641","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6626.66,"10th_percentile":6626.66,"90th_percentile":6626.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":56079.84,"10th_percentile":56079.84,"90th_percentile":56079.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4973.19,"10th_percentile":4973.19,"90th_percentile":4973.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":57652.53,"10th_percentile":57652.53,"90th_percentile":58624.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Brachytx, non-str, HDR Ir-192","code_information":[{"code":"2646","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7558.77,"10th_percentile":7558.77,"90th_percentile":7558.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":45978.22,"10th_percentile":45978.22,"90th_percentile":45978.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4062.5,"10th_percentile":4062.5,"90th_percentile":4062.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":46402.24,"10th_percentile":43633.29,"90th_percentile":50793.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10488.8,"10th_percentile":10488.8,"90th_percentile":10488.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6540.28,"10th_percentile":6540.28,"90th_percentile":6540.28,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1199","median_amount":443.4,"10th_percentile":173.4,"90th_percentile":1293.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":"102","median_amount":259.81,"10th_percentile":179.76,"90th_percentile":476.15,"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 ($): FEE SCHEDULE]","count":"982","median_amount":134.33,"10th_percentile":125.59,"90th_percentile":298.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.21,"10th_percentile":199.21,"90th_percentile":199.21,"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] [APC ($): FEE SCHEDULE]","count":"1218","median_amount":782.12,"10th_percentile":352.27,"90th_percentile":2171.01,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1441","median_amount":40.0,"10th_percentile":15.0,"90th_percentile":90.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":606.0,"10th_percentile":525.26,"90th_percentile":1041.52},{"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":"3524","median_amount":286.69,"10th_percentile":191.63,"90th_percentile":486.31,"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":"275","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":311.96,"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 ($): FEE SCHEDULE]","count":"57","median_amount":124.94,"10th_percentile":124.94,"90th_percentile":245.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"8109","median_amount":770.61,"10th_percentile":328.85,"90th_percentile":2218.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"849","median_amount":299.85,"10th_percentile":103.6,"90th_percentile":855.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":190.53,"10th_percentile":76.69,"90th_percentile":308.83,"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":"57","median_amount":301.48,"10th_percentile":187.79,"90th_percentile":511.11,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":148.86,"10th_percentile":148.86,"90th_percentile":148.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.49,"10th_percentile":118.49,"90th_percentile":333.88,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1428","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":313.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"62","median_amount":185.85,"10th_percentile":127.7,"90th_percentile":281.82,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":294.84,"10th_percentile":157.82,"90th_percentile":486.31,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.19,"10th_percentile":132.19,"90th_percentile":298.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"75","median_amount":219.84,"10th_percentile":164.74,"90th_percentile":463.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":136.16,"10th_percentile":136.16,"90th_percentile":201.95,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1529","median_amount":457.0,"10th_percentile":107.88,"90th_percentile":460.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"213","median_amount":457.0,"10th_percentile":179.18,"90th_percentile":457.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"631","median_amount":131.66,"10th_percentile":124.99,"90th_percentile":302.58,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":97.35,"10th_percentile":85.93,"90th_percentile":131.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":236.73,"10th_percentile":236.73,"90th_percentile":236.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":673.8,"10th_percentile":673.8,"90th_percentile":673.8,"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":"14","median_amount":215.53,"10th_percentile":184.25,"90th_percentile":365.11,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.79,"10th_percentile":89.95,"90th_percentile":209.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"13","median_amount":963.47,"10th_percentile":772.7,"90th_percentile":1543.39,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"21","median_amount":671.0,"10th_percentile":422.28,"90th_percentile":1118.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"90","median_amount":215.53,"10th_percentile":157.82,"90th_percentile":330.96,"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":"1 through 10","median_amount":127.31,"10th_percentile":127.31,"90th_percentile":127.31,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.36,"10th_percentile":85.36,"90th_percentile":85.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"88","median_amount":823.0,"10th_percentile":451.98,"90th_percentile":1264.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":268.2,"10th_percentile":137.1,"90th_percentile":459.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":215.53,"10th_percentile":144.59,"90th_percentile":263.52,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"13","median_amount":91.79,"10th_percentile":89.95,"90th_percentile":232.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":87.62,"10th_percentile":87.62,"90th_percentile":87.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"26","median_amount":206.93,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":90.32,"10th_percentile":90.32,"90th_percentile":90.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":210.14,"10th_percentile":210.14,"90th_percentile":220.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":139.78,"10th_percentile":139.78,"90th_percentile":139.78,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"16","median_amount":412.0,"10th_percentile":153.72,"90th_percentile":412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":409.0,"10th_percentile":409.0,"90th_percentile":409.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":91.79,"10th_percentile":85.45,"90th_percentile":231.57,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":409.17,"10th_percentile":409.17,"90th_percentile":409.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"56","median_amount":852.66,"10th_percentile":484.02,"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":"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":239.81,"10th_percentile":173.47,"90th_percentile":373.99,"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":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":223.58,"10th_percentile":200.14,"90th_percentile":234.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":351.38,"10th_percentile":351.38,"90th_percentile":351.38,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"43","median_amount":1094.69,"10th_percentile":893.26,"90th_percentile":1465.63,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"97","median_amount":1012.0,"10th_percentile":772.16,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":1067.7,"10th_percentile":1067.7,"90th_percentile":1067.7},{"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":"597","median_amount":254.36,"10th_percentile":182.37,"90th_percentile":429.45,"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":232.68,"10th_percentile":123.17,"90th_percentile":282.49,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":224.11,"10th_percentile":224.11,"90th_percentile":224.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"393","median_amount":1065.1,"10th_percentile":758.83,"90th_percentile":1160.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"44","median_amount":487.55,"10th_percentile":237.64,"90th_percentile":584.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":206.5,"10th_percentile":99.29,"90th_percentile":235.17,"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":"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":"121","median_amount":247.74,"10th_percentile":184.25,"90th_percentile":429.45,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":234.57,"10th_percentile":234.57,"90th_percentile":234.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"50","median_amount":217.3,"10th_percentile":97.44,"90th_percentile":253.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":145.74,"10th_percentile":137.03,"90th_percentile":159.65,"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":"118","median_amount":243.24,"10th_percentile":182.37,"90th_percentile":414.27,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":213.53,"10th_percentile":213.53,"90th_percentile":213.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"65","median_amount":251.25,"10th_percentile":186.95,"90th_percentile":344.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":201.53,"10th_percentile":201.53,"90th_percentile":201.53,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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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] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. 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The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":231.47,"10th_percentile":199.75,"90th_percentile":313.35,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":200.29,"10th_percentile":95.17,"90th_percentile":211.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":192.92,"10th_percentile":180.4,"90th_percentile":319.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"565","median_amount":1449.95,"10th_percentile":599.28,"90th_percentile":2122.88,"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":"638","median_amount":282.27,"10th_percentile":206.98,"90th_percentile":418.06,"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 ($): FEE SCHEDULE]","count":"309","median_amount":355.96,"10th_percentile":230.96,"90th_percentile":466.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":369.58,"10th_percentile":330.65,"90th_percentile":472.96,"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] [APC ($): FEE SCHEDULE]","count":"487","median_amount":2308.21,"10th_percentile":1647.71,"90th_percentile":3327.76,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"987","median_amount":2264.0,"10th_percentile":1714.0,"90th_percentile":3173.72,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":3111.38,"10th_percentile":3111.38,"90th_percentile":3111.38},{"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":"4583","median_amount":289.49,"10th_percentile":198.58,"90th_percentile":430.62,"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":"114","median_amount":404.19,"10th_percentile":281.08,"90th_percentile":483.86,"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 ($): FEE SCHEDULE]","count":"61","median_amount":389.15,"10th_percentile":339.03,"90th_percentile":471.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"3860","median_amount":2248.89,"10th_percentile":1607.0,"90th_percentile":3223.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"479","median_amount":886.9,"10th_percentile":435.97,"90th_percentile":1339.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"59","median_amount":284.25,"10th_percentile":216.26,"90th_percentile":521.04,"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":"999","median_amount":292.28,"10th_percentile":213.64,"90th_percentile":446.57,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":339.21,"10th_percentile":278.51,"90th_percentile":416.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":377.99,"10th_percentile":377.99,"90th_percentile":377.99,"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 ($): FEE SCHEDULE]","count":"640","median_amount":297.56,"10th_percentile":149.08,"90th_percentile":467.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":270.61,"10th_percentile":184.19,"90th_percentile":497.38,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"980","median_amount":282.27,"10th_percentile":187.94,"90th_percentile":430.62,"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 ($): FEE SCHEDULE]","count":"30","median_amount":282.76,"10th_percentile":256.04,"90th_percentile":380.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"568","median_amount":294.76,"10th_percentile":221.48,"90th_percentile":450.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":331.75,"10th_percentile":303.69,"90th_percentile":443.47,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"702","median_amount":921.27,"10th_percentile":274.55,"90th_percentile":973.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"88","median_amount":929.0,"10th_percentile":466.0,"90th_percentile":966.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"308","median_amount":353.46,"10th_percentile":260.36,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":329.3,"10th_percentile":216.26,"90th_percentile":406.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"46","median_amount":295.48,"10th_percentile":192.96,"90th_percentile":414.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":282.76,"10th_percentile":221.16,"90th_percentile":409.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1198","median_amount":3038.4,"10th_percentile":1157.2,"90th_percentile":4506.84,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"575","median_amount":599.3,"10th_percentile":283.95,"90th_percentile":1066.34,"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":"[APC ($): FEE SCHEDULE]","count":"881","median_amount":773.45,"10th_percentile":543.32,"90th_percentile":1075.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":693.65,"10th_percentile":444.57,"90th_percentile":857.84,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1025","median_amount":6221.94,"10th_percentile":3994.74,"90th_percentile":14177.04,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1762","median_amount":5884.0,"10th_percentile":4043.85,"90th_percentile":15080.07,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"15","median_amount":8164.6,"10th_percentile":4555.53,"90th_percentile":16596.85},{"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":"4291","median_amount":580.36,"10th_percentile":282.27,"90th_percentile":1052.98,"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":"316","median_amount":770.9,"10th_percentile":565.58,"90th_percentile":1115.44,"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":"[APC ($): FEE SCHEDULE]","count":"152","median_amount":780.07,"10th_percentile":541.43,"90th_percentile":1183.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"7312","median_amount":5880.52,"10th_percentile":3948.31,"90th_percentile":14813.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"932","median_amount":1815.01,"10th_percentile":983.32,"90th_percentile":4186.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"137","median_amount":737.57,"10th_percentile":506.26,"90th_percentile":1054.78,"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":"957","median_amount":574.82,"10th_percentile":285.93,"90th_percentile":1002.26,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":666.45,"10th_percentile":426.42,"90th_percentile":892.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":655.51,"10th_percentile":522.45,"90th_percentile":843.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1741","median_amount":698.32,"10th_percentile":416.43,"90th_percentile":1098.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"99","median_amount":626.04,"10th_percentile":441.64,"90th_percentile":936.39,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"916","median_amount":582.31,"10th_percentile":282.27,"90th_percentile":1056.09,"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":"[APC ($): FEE SCHEDULE]","count":"38","median_amount":681.17,"10th_percentile":518.6,"90th_percentile":1047.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"496","median_amount":549.78,"10th_percentile":294.05,"90th_percentile":1043.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"44","median_amount":602.21,"10th_percentile":415.02,"90th_percentile":796.37,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":612.59,"10th_percentile":612.59,"90th_percentile":612.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1475","median_amount":1272.45,"10th_percentile":496.58,"90th_percentile":1497.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"216","median_amount":1186.0,"10th_percentile":578.8,"90th_percentile":1486.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"868","median_amount":729.9,"10th_percentile":512.57,"90th_percentile":1102.77,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"79","median_amount":710.58,"10th_percentile":477.03,"90th_percentile":1138.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"11","median_amount":513.16,"10th_percentile":282.27,"90th_percentile":980.63,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":662.94,"10th_percentile":476.02,"90th_percentile":923.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"476","median_amount":4125.17,"10th_percentile":1753.57,"90th_percentile":6746.51,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"247","median_amount":891.49,"10th_percentile":426.15,"90th_percentile":1537.09,"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 ($): FEE SCHEDULE]","count":"584","median_amount":1287.68,"10th_percentile":815.01,"90th_percentile":3048.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"26","median_amount":1020.28,"10th_percentile":804.53,"90th_percentile":2893.59,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"381","median_amount":12949.25,"10th_percentile":6786.56,"90th_percentile":24729.04,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"625","median_amount":12280.0,"10th_percentile":7269.86,"90th_percentile":25172.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":12244.16,"10th_percentile":12244.16,"90th_percentile":12904.49},{"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":"1519","median_amount":910.51,"10th_percentile":365.04,"90th_percentile":1561.09,"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":"[APC ($): FEE SCHEDULE]","count":"221","median_amount":1269.71,"10th_percentile":924.24,"90th_percentile":2982.52,"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 ($): FEE SCHEDULE]","count":"109","median_amount":1237.65,"10th_percentile":925.28,"90th_percentile":2883.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"2500","median_amount":11933.83,"10th_percentile":6894.02,"90th_percentile":24452.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"322","median_amount":3677.06,"10th_percentile":1548.4,"90th_percentile":7382.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":1232.48,"10th_percentile":795.51,"90th_percentile":2944.05,"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":"[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":841.92,"10th_percentile":364.05,"90th_percentile":1434.94,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2675.76,"10th_percentile":910.2,"90th_percentile":3057.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":889.29,"10th_percentile":740.81,"90th_percentile":1438.82,"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 ($): FEE SCHEDULE]","count":"1177","median_amount":1201.62,"10th_percentile":698.32,"90th_percentile":3030.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"63","median_amount":1055.51,"10th_percentile":550.11,"90th_percentile":2356.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"361","median_amount":872.27,"10th_percentile":400.37,"90th_percentile":1662.95,"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 ($): FEE SCHEDULE]","count":"42","median_amount":1039.91,"10th_percentile":819.9,"90th_percentile":2327.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"196","median_amount":885.75,"10th_percentile":409.92,"90th_percentile":1513.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":1027.94,"10th_percentile":632.48,"90th_percentile":2434.59,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":912.54,"10th_percentile":912.54,"90th_percentile":912.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"533","median_amount":1820.7,"10th_percentile":778.4,"90th_percentile":4393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"99","median_amount":1858.0,"10th_percentile":966.0,"90th_percentile":4361.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"600","median_amount":1276.01,"10th_percentile":846.43,"90th_percentile":3047.51,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":1240.84,"10th_percentile":762.13,"90th_percentile":2944.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":490.66,"10th_percentile":376.89,"90th_percentile":1403.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":1122.59,"10th_percentile":804.17,"90th_percentile":1624.52,"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":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"13","median_amount":3918.54,"10th_percentile":3381.8,"90th_percentile":8384.03,"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":"1 through 10","median_amount":1321.43,"10th_percentile":997.03,"90th_percentile":1901.25,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2681.58,"10th_percentile":1414.52,"90th_percentile":2881.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24146.38,"10th_percentile":11359.04,"90th_percentile":36320.67,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":21233.0,"10th_percentile":10031.0,"90th_percentile":40746.37,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":11415.86,"10th_percentile":11415.86,"90th_percentile":11415.86},{"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":1124.95,"10th_percentile":614.63,"90th_percentile":1841.12,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1582.49,"10th_percentile":958.71,"90th_percentile":3104.95,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1241.56,"10th_percentile":1241.56,"90th_percentile":1241.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"57","median_amount":12893.12,"10th_percentile":9227.36,"90th_percentile":46918.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3542.7,"10th_percentile":3186.05,"90th_percentile":11724.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1528.22,"10th_percentile":1528.22,"90th_percentile":1528.22,"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":"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":1176.52,"10th_percentile":434.73,"90th_percentile":3138.96,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"21","median_amount":2376.81,"10th_percentile":1489.91,"90th_percentile":3261.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":"14","median_amount":1071.32,"10th_percentile":406.12,"90th_percentile":2524.14,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1444.49,"10th_percentile":1444.49,"90th_percentile":1444.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1536.92,"10th_percentile":586.55,"90th_percentile":2715.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"12","median_amount":2769.0,"10th_percentile":2643.0,"90th_percentile":4393.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3489.6,"10th_percentile":3489.6,"90th_percentile":4362.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2905.92,"10th_percentile":1748.13,"90th_percentile":3091.43,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1972.51,"10th_percentile":1972.51,"90th_percentile":1972.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":970.98,"10th_percentile":970.98,"90th_percentile":970.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"34","median_amount":1242.48,"10th_percentile":461.29,"90th_percentile":2130.18,"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":"1 through 10","median_amount":629.26,"10th_percentile":207.33,"90th_percentile":878.96,"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 ($): FEE SCHEDULE]","count":"38","median_amount":336.01,"10th_percentile":216.65,"90th_percentile":947.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"49","median_amount":1972.0,"10th_percentile":1288.53,"90th_percentile":3706.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"38","median_amount":65.6,"10th_percentile":20.0,"90th_percentile":1087.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":550.38,"10th_percentile":313.77,"90th_percentile":878.96,"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":"17","median_amount":335.34,"10th_percentile":228.25,"90th_percentile":677.28,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"266","median_amount":1836.55,"10th_percentile":1231.0,"90th_percentile":3566.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"22","median_amount":721.7,"10th_percentile":335.76,"90th_percentile":941.42},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":301.18,"10th_percentile":301.18,"90th_percentile":483.87,"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 ($): FEE SCHEDULE]","count":"80","median_amount":407.18,"10th_percentile":193.19,"90th_percentile":781.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":521.31,"10th_percentile":441.17,"90th_percentile":576.62,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"34","median_amount":460.0,"10th_percentile":460.0,"90th_percentile":1936.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":457.0,"10th_percentile":457.0,"90th_percentile":2211.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":335.45,"10th_percentile":183.39,"90th_percentile":1075.28,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"20","median_amount":2152.6,"10th_percentile":600.48,"90th_percentile":3743.12,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":614.94,"10th_percentile":504.25,"90th_percentile":649.47,"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 ($): FEE SCHEDULE]","count":"12","median_amount":611.14,"10th_percentile":223.82,"90th_percentile":866.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"14","median_amount":2446.48,"10th_percentile":1588.97,"90th_percentile":5437.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"17","median_amount":2876.0,"10th_percentile":90.0,"90th_percentile":15470.72,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":2463.13,"10th_percentile":2463.13,"90th_percentile":2463.13},{"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":"43","median_amount":528.01,"10th_percentile":365.48,"90th_percentile":662.04,"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":"1 through 10","median_amount":758.14,"10th_percentile":415.65,"90th_percentile":1381.1,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"85","median_amount":3341.43,"10th_percentile":1896.02,"90th_percentile":11303.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":1178.06,"10th_percentile":674.62,"90th_percentile":3483.91},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":631.85,"10th_percentile":342.42,"90th_percentile":649.47,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"28","median_amount":631.78,"10th_percentile":344.61,"90th_percentile":1257.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1120.99,"10th_percentile":525.75,"90th_percentile":1120.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":631.85,"10th_percentile":368.59,"90th_percentile":1033.89,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":559.3,"10th_percentile":559.3,"90th_percentile":559.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":658.3,"10th_percentile":557.57,"90th_percentile":668.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"25","median_amount":729.75,"10th_percentile":460.0,"90th_percentile":4344.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":742.81,"10th_percentile":537.18,"90th_percentile":1082.86,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9426.94,"10th_percentile":9426.94,"90th_percentile":9426.94,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1038.44,"10th_percentile":1038.44,"90th_percentile":1038.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20476.03,"10th_percentile":8084.55,"90th_percentile":21158.14,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":7737.79,"10th_percentile":7737.79,"90th_percentile":19586.48,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":501.48,"10th_percentile":399.37,"90th_percentile":536.01,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2085.48,"10th_percentile":2085.48,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1237.36,"10th_percentile":1237.36,"90th_percentile":1237.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":10882.67,"10th_percentile":5932.38,"90th_percentile":15245.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5762.76,"10th_percentile":5762.76,"90th_percentile":5762.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1089.56,"10th_percentile":1089.56,"90th_percentile":1089.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":973.0,"10th_percentile":973.0,"90th_percentile":973.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":7702.74,"10th_percentile":7702.74,"90th_percentile":8369.78,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2122.6,"10th_percentile":1868.69,"90th_percentile":2808.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20322.07,"10th_percentile":19063.51,"90th_percentile":39289.64,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":22704.4,"10th_percentile":17159.21,"90th_percentile":26533.92,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2258.93,"10th_percentile":1635.72,"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":2803.77,"10th_percentile":2803.77,"90th_percentile":2803.77,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"31","median_amount":17530.32,"10th_percentile":6879.0,"90th_percentile":30632.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2058.93,"10th_percentile":2058.93,"90th_percentile":2058.93},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"18","median_amount":2181.36,"10th_percentile":1741.83,"90th_percentile":2934.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":2438.31,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4856.36,"10th_percentile":4164.0,"90th_percentile":12486.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6201.0,"10th_percentile":6201.0,"90th_percentile":6201.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1501.5,"10th_percentile":1501.5,"90th_percentile":1501.5,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5903.19,"10th_percentile":5903.19,"90th_percentile":5903.19,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3372.73,"10th_percentile":3372.73,"90th_percentile":3372.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":35616.22,"10th_percentile":35616.22,"90th_percentile":35616.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2438.31,"10th_percentile":2438.31,"90th_percentile":2438.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5614.64,"10th_percentile":5614.64,"90th_percentile":5614.64,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":29103.62,"10th_percentile":28923.48,"90th_percentile":29193.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3747.94,"10th_percentile":3747.94,"90th_percentile":4052.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6647.5,"10th_percentile":6647.5,"90th_percentile":6647.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4274.22,"10th_percentile":3878.29,"90th_percentile":5577.07,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"30","median_amount":1765.59,"10th_percentile":1173.5,"90th_percentile":8419.37,"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 ($): FEE SCHEDULE]","count":"18","median_amount":725.77,"10th_percentile":718.77,"90th_percentile":965.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"16","median_amount":4492.0,"10th_percentile":3207.0,"90th_percentile":7110.72,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"45","median_amount":3851.0,"10th_percentile":3526.0,"90th_percentile":11809.32,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"58","median_amount":760.4,"10th_percentile":388.62,"90th_percentile":857.53,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":718.77,"10th_percentile":654.1,"90th_percentile":1661.47,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":712.51,"10th_percentile":712.51,"90th_percentile":712.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"121","median_amount":4495.0,"10th_percentile":3486.29,"90th_percentile":12794.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2125.75,"10th_percentile":988.12,"90th_percentile":4468.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":547.27,"10th_percentile":547.27,"90th_percentile":547.27,"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":"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":758.54,"10th_percentile":388.62,"90th_percentile":1347.12,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":835.57,"10th_percentile":835.57,"90th_percentile":835.57,"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 ($): FEE SCHEDULE]","count":"45","median_amount":718.77,"10th_percentile":571.77,"90th_percentile":726.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":700.06,"10th_percentile":700.06,"90th_percentile":700.06,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":311.65,"10th_percentile":311.65,"90th_percentile":321.88,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":839.77,"10th_percentile":839.77,"90th_percentile":1435.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"26","median_amount":3025.0,"10th_percentile":929.0,"90th_percentile":3169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":457.0,"10th_percentile":457.0,"90th_percentile":2915.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":719.18,"10th_percentile":351.28,"90th_percentile":1282.25,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":839.48,"10th_percentile":839.48,"90th_percentile":839.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"72","median_amount":3889.01,"10th_percentile":1942.17,"90th_percentile":7957.05,"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":1758.44,"10th_percentile":1120.71,"90th_percentile":2212.09,"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 ($): FEE SCHEDULE]","count":"57","median_amount":1660.6,"10th_percentile":1145.92,"90th_percentile":1753.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"77","median_amount":9346.0,"10th_percentile":7155.54,"90th_percentile":18150.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"138","median_amount":8601.0,"10th_percentile":6442.0,"90th_percentile":18432.71,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"119","median_amount":1653.83,"10th_percentile":100.46,"90th_percentile":1919.37,"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":"18","median_amount":1655.19,"10th_percentile":1287.69,"90th_percentile":1742.88,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1570.74,"10th_percentile":1570.74,"90th_percentile":1653.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"471","median_amount":9774.69,"10th_percentile":7227.88,"90th_percentile":19526.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"61","median_amount":2887.33,"10th_percentile":1333.15,"90th_percentile":6267.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1571.38,"10th_percentile":1483.69,"90th_percentile":1658.69,"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":"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":1670.6,"10th_percentile":1518.74,"90th_percentile":2247.22,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1489.67,"10th_percentile":1489.67,"90th_percentile":1489.67,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"104","median_amount":1658.19,"10th_percentile":1479.21,"90th_percentile":1753.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1612.09,"10th_percentile":1612.09,"90th_percentile":1612.09,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1801.18,"10th_percentile":1801.18,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1549.11,"10th_percentile":397.44,"90th_percentile":1800.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"101","median_amount":4054.6,"10th_percentile":2353.18,"90th_percentile":4989.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"22","median_amount":4134.0,"10th_percentile":3307.2,"90th_percentile":4953.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":1655.2,"10th_percentile":1268.1,"90th_percentile":2007.52,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":7438.55,"10th_percentile":5808.36,"90th_percentile":8432.63,"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":"1 through 10","median_amount":2444.76,"10th_percentile":2444.76,"90th_percentile":2444.76,"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 ($): FEE SCHEDULE]","count":"13","median_amount":2927.79,"10th_percentile":2830.79,"90th_percentile":2965.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18834.02,"10th_percentile":12705.2,"90th_percentile":36472.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"15","median_amount":15771.62,"10th_percentile":9657.92,"90th_percentile":36012.58,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2247.22,"10th_percentile":2155.26,"90th_percentile":2915.92,"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":2929.79,"10th_percentile":2923.79,"90th_percentile":2929.79,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"64","median_amount":19074.17,"10th_percentile":12886.67,"90th_percentile":30546.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5939.85,"10th_percentile":5325.73,"90th_percentile":6602.44},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":2907.07,"10th_percentile":2907.07,"90th_percentile":2915.92,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2637.91,"10th_percentile":2637.91,"90th_percentile":2637.91,"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 ($): FEE SCHEDULE]","count":"33","median_amount":2923.79,"10th_percentile":2689.8,"90th_percentile":2926.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2753.21,"10th_percentile":2753.21,"90th_percentile":2753.21,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2791.03,"10th_percentile":2791.03,"90th_percentile":4513.92,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2965.77,"10th_percentile":2965.77,"90th_percentile":2965.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2296.29,"10th_percentile":2296.29,"90th_percentile":2296.29,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"11","median_amount":3135.8,"10th_percentile":2467.91,"90th_percentile":4984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4984.0,"10th_percentile":4984.0,"90th_percentile":4984.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":2923.8,"10th_percentile":2536.7,"90th_percentile":2931.7,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"13","median_amount":9570.08,"10th_percentile":8725.18,"90th_percentile":12194.36,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6662.14,"10th_percentile":3911.89,"90th_percentile":6820.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"12","median_amount":17097.4,"10th_percentile":13681.87,"90th_percentile":48893.78,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"25","median_amount":18513.53,"10th_percentile":14488.1,"90th_percentile":37372.4,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2505.9,"10th_percentile":1603.91,"90th_percentile":6080.5,"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":3917.89,"10th_percentile":3911.89,"90th_percentile":6662.48,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3712.3,"10th_percentile":3712.3,"90th_percentile":3712.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"82","median_amount":21077.87,"10th_percentile":15117.79,"90th_percentile":47809.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5013.37,"10th_percentile":4118.8,"90th_percentile":14411.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6683.49,"10th_percentile":6683.49,"90th_percentile":6683.49,"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":"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":5533.37,"10th_percentile":5533.37,"90th_percentile":5533.37,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"21","median_amount":3919.89,"10th_percentile":3764.89,"90th_percentile":6662.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3810.02,"10th_percentile":3810.02,"90th_percentile":6488.65,"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":"1 through 10","median_amount":3990.78,"10th_percentile":3990.78,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3908.1,"10th_percentile":3908.1,"90th_percentile":3908.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"18","median_amount":7102.0,"10th_percentile":5020.0,"90th_percentile":8733.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7051.0,"10th_percentile":7051.0,"90th_percentile":7476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3927.86,"10th_percentile":3681.59,"90th_percentile":6757.34,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":10029.93,"10th_percentile":10029.93,"90th_percentile":10581.76,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6671.69,"10th_percentile":6671.69,"90th_percentile":6671.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":44251.73,"10th_percentile":44251.73,"90th_percentile":46187.39,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":60933.94,"10th_percentile":54876.9,"90th_percentile":71610.07,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":6127.66,"10th_percentile":3922.03,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"17","median_amount":55331.81,"10th_percentile":33955.09,"90th_percentile":93066.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":13609.33,"10th_percentile":13609.33,"90th_percentile":17078.6},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6665.64,"10th_percentile":6665.64,"90th_percentile":6665.64,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5995.92,"10th_percentile":5995.92,"90th_percentile":5995.92,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6665.14,"10th_percentile":6368.14,"90th_percentile":6870.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9858.34,"10th_percentile":8816.0,"90th_percentile":174544.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9208.0,"10th_percentile":9208.0,"90th_percentile":9208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6662.47,"10th_percentile":6170.07,"90th_percentile":6754.84,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":11086.83,"10th_percentile":11086.83,"90th_percentile":11086.83,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9780.47,"10th_percentile":9780.47,"90th_percentile":9780.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":58712.78,"10th_percentile":37255.9,"90th_percentile":69877.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":69243.41,"10th_percentile":69243.41,"90th_percentile":69243.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18957.09,"10th_percentile":18957.09,"90th_percentile":18957.09},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":186880.75,"10th_percentile":165972.99,"90th_percentile":193607.68,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":118503.29,"10th_percentile":92752.86,"90th_percentile":147816.21,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":175842.13,"10th_percentile":175842.13,"90th_percentile":175842.13},{"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":16267.91,"10th_percentile":16267.91,"90th_percentile":16267.91,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"12","median_amount":184701.06,"10th_percentile":107946.87,"90th_percentile":201402.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":66856.41,"10th_percentile":28808.63,"90th_percentile":73543.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":27857.09,"10th_percentile":24492.3,"90th_percentile":28219.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"16","median_amount":1734.59,"10th_percentile":394.8,"90th_percentile":2271.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":1209.77,"10th_percentile":866.63,"90th_percentile":1776.33,"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 ($): FEE SCHEDULE]","count":"35","median_amount":294.04,"10th_percentile":89.26,"90th_percentile":791.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"24","median_amount":2718.91,"10th_percentile":1945.0,"90th_percentile":4012.25,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"18","median_amount":40.0,"10th_percentile":30.0,"90th_percentile":763.31,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":443.19,"10th_percentile":310.62,"90th_percentile":1120.63,"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":"12","median_amount":746.88,"10th_percentile":302.07,"90th_percentile":1069.25,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1042.74,"10th_percentile":848.36,"90th_percentile":1042.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"111","median_amount":2296.84,"10th_percentile":315.0,"90th_percentile":4409.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"16","median_amount":969.21,"10th_percentile":447.27,"90th_percentile":1425.4},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":95.05,"10th_percentile":95.05,"90th_percentile":95.05,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":441.13,"10th_percentile":441.13,"90th_percentile":441.13,"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 ($): FEE SCHEDULE]","count":"45","median_amount":496.03,"10th_percentile":241.99,"90th_percentile":1213.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":95.05,"10th_percentile":95.05,"90th_percentile":165.57,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"17","median_amount":628.82,"10th_percentile":370.0,"90th_percentile":2822.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1743.0,"10th_percentile":457.0,"90th_percentile":3870.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":378.35,"10th_percentile":131.66,"90th_percentile":707.31,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"20","median_amount":1764.6,"10th_percentile":1017.6,"90th_percentile":2302.2,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":369.19,"10th_percentile":369.19,"90th_percentile":369.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"18","median_amount":2897.38,"10th_percentile":2384.17,"90th_percentile":5204.54,"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":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"20","median_amount":40.0,"10th_percentile":30.0,"90th_percentile":2621.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1024.15,"10th_percentile":924.54,"90th_percentile":1088.42,"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":"1 through 10","median_amount":506.44,"10th_percentile":506.44,"90th_percentile":506.44,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"127","median_amount":2927.38,"10th_percentile":2094.96,"90th_percentile":3841.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"15","median_amount":1229.55,"10th_percentile":1174.6,"90th_percentile":2455.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":929.14,"10th_percentile":929.14,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":683.53,"10th_percentile":625.99,"90th_percentile":683.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1065.47,"10th_percentile":532.8,"90th_percentile":1106.63,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"30","median_amount":460.0,"10th_percentile":368.0,"90th_percentile":482.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":666.42,"10th_percentile":646.43,"90th_percentile":763.93,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3489.37,"10th_percentile":3113.83,"90th_percentile":6915.68,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1638.32,"10th_percentile":1638.32,"90th_percentile":2687.01,"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 ($): FEE SCHEDULE]","count":"11","median_amount":1642.77,"10th_percentile":1640.38,"90th_percentile":2128.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"13","median_amount":14456.93,"10th_percentile":11888.65,"90th_percentile":19674.71,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"27","median_amount":15079.25,"10th_percentile":8851.0,"90th_percentile":21351.65,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1212.03,"10th_percentile":784.8,"90th_percentile":2133.59,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1640.93,"10th_percentile":1640.93,"90th_percentile":1648.51,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2042.6,"10th_percentile":2042.6,"90th_percentile":2042.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"89","median_amount":15612.25,"10th_percentile":7991.0,"90th_percentile":22865.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":4968.43,"10th_percentile":3980.2,"90th_percentile":6180.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1101.94,"10th_percentile":1101.94,"90th_percentile":1101.94,"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":"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":1099.05,"10th_percentile":683.13,"90th_percentile":1638.32,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1476.79,"10th_percentile":1476.79,"90th_percentile":1476.79,"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 ($): FEE SCHEDULE]","count":"18","median_amount":1638.27,"10th_percentile":1243.27,"90th_percentile":2213.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1592.65,"10th_percentile":1592.65,"90th_percentile":1592.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":883.54,"10th_percentile":883.54,"90th_percentile":883.54,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":723.97,"10th_percentile":715.62,"90th_percentile":855.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2049.53,"10th_percentile":2049.53,"90th_percentile":2049.53,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"12","median_amount":4989.5,"10th_percentile":1047.9,"90th_percentile":7102.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3824.0,"10th_percentile":3307.24,"90th_percentile":3987.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1639.94,"10th_percentile":1317.44,"90th_percentile":2298.19,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1918.79,"10th_percentile":1918.79,"90th_percentile":1918.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"42","median_amount":8343.89,"10th_percentile":5412.16,"90th_percentile":8959.28,"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":"1 through 10","median_amount":2879.9,"10th_percentile":2704.95,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"19","median_amount":3322.92,"10th_percentile":3217.88,"90th_percentile":3503.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"31","median_amount":26075.78,"10th_percentile":18829.85,"90th_percentile":38400.84,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"56","median_amount":26035.9,"10th_percentile":18149.43,"90th_percentile":44741.52,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2686.13,"10th_percentile":1638.32,"90th_percentile":6616.24,"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":"1 through 10","median_amount":3314.6,"10th_percentile":2947.1,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3145.49,"10th_percentile":3145.49,"90th_percentile":3145.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"149","median_amount":24423.66,"10th_percentile":16718.34,"90th_percentile":48364.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"39","median_amount":7619.29,"10th_percentile":5449.58,"90th_percentile":10784.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7301.33,"10th_percentile":7301.33,"90th_percentile":7301.33,"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":"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":2686.13,"10th_percentile":2578.9,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2988.9,"10th_percentile":2988.9,"90th_percentile":2988.9,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":3314.6,"10th_percentile":3167.6,"90th_percentile":3328.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3228.29,"10th_percentile":2633.95,"90th_percentile":3228.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2686.13,"10th_percentile":2578.9,"90th_percentile":7383.12,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2630.48,"10th_percentile":2630.48,"90th_percentile":2630.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"29","median_amount":5822.0,"10th_percentile":4027.34,"90th_percentile":7530.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6599.5,"10th_percentile":5780.0,"90th_percentile":26771.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":3319.61,"10th_percentile":2664.38,"90th_percentile":3325.44,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"53","median_amount":9885.95,"10th_percentile":7058.48,"90th_percentile":13227.35,"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":"11","median_amount":5892.56,"10th_percentile":959.35,"90th_percentile":10578.39,"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 ($): FEE SCHEDULE]","count":"48","median_amount":7303.46,"10th_percentile":1369.81,"90th_percentile":7499.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7006.24,"10th_percentile":7006.24,"90th_percentile":7006.24,"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] [APC ($): FEE SCHEDULE]","count":"52","median_amount":49517.0,"10th_percentile":22646.69,"90th_percentile":90485.35,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"95","median_amount":64278.61,"10th_percentile":34729.14,"90th_percentile":95222.88,"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":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":59248.1,"10th_percentile":59248.1,"90th_percentile":59248.1},{"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":"212","median_amount":1439.02,"10th_percentile":864.25,"90th_percentile":9725.18,"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":"16","median_amount":7297.83,"10th_percentile":1364.25,"90th_percentile":7482.7,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":866.14,"10th_percentile":863.09,"90th_percentile":7198.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"341","median_amount":50071.03,"10th_percentile":32782.63,"90th_percentile":90271.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"58","median_amount":15926.74,"10th_percentile":9805.45,"90th_percentile":26900.51},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7304.33,"10th_percentile":1045.75,"90th_percentile":7306.32,"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":"[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":7824.12,"10th_percentile":1381.57,"90th_percentile":14286.65,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1369.74,"10th_percentile":1369.74,"90th_percentile":1369.74,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"109","median_amount":6767.57,"10th_percentile":713.46,"90th_percentile":7481.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":1328.72,"10th_percentile":689.04,"90th_percentile":7107.8,"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":"[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":6813.84,"10th_percentile":965.35,"90th_percentile":12939.25,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1455.2,"10th_percentile":1455.2,"90th_percentile":1455.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":7536.48,"10th_percentile":6013.03,"90th_percentile":11708.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6116.12,"10th_percentile":6116.12,"90th_percentile":6116.12,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"98","median_amount":9130.68,"10th_percentile":3169.0,"90th_percentile":21205.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"11","median_amount":14571.43,"10th_percentile":2516.8,"90th_percentile":23194.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"40","median_amount":7067.54,"10th_percentile":727.61,"90th_percentile":7373.89,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7302.83,"10th_percentile":7302.83,"90th_percentile":7302.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9842.12,"10th_percentile":9842.12,"90th_percentile":9842.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"43","median_amount":13511.39,"10th_percentile":11332.77,"90th_percentile":21788.8,"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":15518.17,"10th_percentile":15518.17,"90th_percentile":15682.4,"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 ($): FEE SCHEDULE]","count":"122","median_amount":13330.65,"10th_percentile":12868.61,"90th_percentile":13356.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"50","median_amount":74553.41,"10th_percentile":61994.09,"90th_percentile":121961.52,"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":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"61","median_amount":68326.51,"10th_percentile":58319.35,"90th_percentile":97352.94,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"49","median_amount":14320.34,"10th_percentile":3658.53,"90th_percentile":16990.02,"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":"42","median_amount":13322.13,"10th_percentile":12895.36,"90th_percentile":13353.94,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12568.32,"10th_percentile":12568.27,"90th_percentile":12665.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"249","median_amount":70018.88,"10th_percentile":59747.21,"90th_percentile":101201.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"28","median_amount":21277.9,"10th_percentile":19500.77,"90th_percentile":34773.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13325.55,"10th_percentile":12880.38,"90th_percentile":13356.1,"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":"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":13587.11,"10th_percentile":12592.93,"90th_percentile":14734.87,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"151","median_amount":13248.05,"10th_percentile":12752.38,"90th_percentile":13358.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12901.39,"10th_percentile":12901.19,"90th_percentile":23350.08,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15496.97,"10th_percentile":14318.3,"90th_percentile":15987.89,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13400.86,"10th_percentile":13400.86,"90th_percentile":13400.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":15416.81,"10th_percentile":15416.81,"90th_percentile":15416.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"58","median_amount":22448.54,"10th_percentile":17624.32,"90th_percentile":25774.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"12","median_amount":22308.0,"10th_percentile":17695.77,"90th_percentile":24987.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":13330.35,"10th_percentile":12654.65,"90th_percentile":13402.6,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":12551.11,"10th_percentile":12551.11,"90th_percentile":12551.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13299.03,"10th_percentile":13299.03,"90th_percentile":13299.03,"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":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":18071.88,"10th_percentile":15567.33,"90th_percentile":25019.92,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"28","median_amount":18888.72,"10th_percentile":18545.72,"90th_percentile":18971.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"14","median_amount":123464.63,"10th_percentile":87566.91,"90th_percentile":190903.94,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"15","median_amount":125182.29,"10th_percentile":79295.68,"90th_percentile":204372.99,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":19104.82,"10th_percentile":19094.26,"90th_percentile":24670.37,"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":"1 through 10","median_amount":18794.26,"10th_percentile":18657.23,"90th_percentile":18972.23,"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":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16722.4,"10th_percentile":16722.4,"90th_percentile":16722.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"92","median_amount":126310.06,"10th_percentile":87488.83,"90th_percentile":216797.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":32509.26,"10th_percentile":27387.53,"90th_percentile":46023.74},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18795.39,"10th_percentile":18795.39,"90th_percentile":18888.72,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"45","median_amount":18790.25,"10th_percentile":18639.76,"90th_percentile":18976.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18396.85,"10th_percentile":18396.85,"90th_percentile":18396.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":23541.71,"10th_percentile":23541.71,"90th_percentile":23541.71,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":27358.5,"10th_percentile":24455.0,"90th_percentile":30229.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":24929.78,"10th_percentile":24929.78,"90th_percentile":24929.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":18786.76,"10th_percentile":17796.34,"90th_percentile":18965.82,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9855.86,"10th_percentile":9855.86,"90th_percentile":9855.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9244.53,"10th_percentile":9244.53,"90th_percentile":9244.53,"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":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":22573.01,"10th_percentile":22573.01,"90th_percentile":22573.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2269.2,"10th_percentile":2269.2,"90th_percentile":3403.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":15699.79,"10th_percentile":11396.61,"90th_percentile":20152.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4161.6,"10th_percentile":4161.6,"90th_percentile":4161.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8367.42,"10th_percentile":8367.42,"90th_percentile":8367.42,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3773.98,"10th_percentile":3773.98,"90th_percentile":3773.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22577.53,"10th_percentile":22577.53,"90th_percentile":22577.53,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":19138.4,"10th_percentile":19138.4,"90th_percentile":19138.4,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2363.55,"10th_percentile":2363.55,"90th_percentile":2363.55,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3574.32,"10th_percentile":3574.32,"90th_percentile":3574.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":19677.11,"10th_percentile":17392.66,"90th_percentile":56596.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3769.98,"10th_percentile":3769.98,"90th_percentile":3769.98,"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":"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":2269.2,"10th_percentile":2269.2,"90th_percentile":2269.2,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":2922.79,"10th_percentile":2922.79,"90th_percentile":2922.79,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5020.0,"10th_percentile":5020.0,"90th_percentile":5020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7476.0,"10th_percentile":7476.0,"90th_percentile":7476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3773.99,"10th_percentile":3773.99,"90th_percentile":3773.99,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":7924.18,"10th_percentile":6689.01,"90th_percentile":10624.17,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7078.8,"10th_percentile":7078.8,"90th_percentile":7078.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40897.29,"10th_percentile":40897.29,"90th_percentile":40897.29,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":41954.79,"10th_percentile":40394.99,"90th_percentile":83418.32,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":10650.24,"10th_percentile":7892.87,"90th_percentile":13990.03,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"20","median_amount":37906.99,"10th_percentile":33545.39,"90th_percentile":51051.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":11836.47,"10th_percentile":11836.47,"90th_percentile":11836.47},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":10661.24,"10th_percentile":10661.24,"90th_percentile":10661.24,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7077.8,"10th_percentile":7019.8,"90th_percentile":7079.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10650.24,"10th_percentile":10650.24,"90th_percentile":10650.24,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4851.36,"10th_percentile":4851.36,"90th_percentile":4851.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7188.0,"10th_percentile":6841.12,"90th_percentile":9009.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11851.29,"10th_percentile":11851.29,"90th_percentile":11851.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":20289.31,"10th_percentile":20289.31,"90th_percentile":25295.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":18049.31,"10th_percentile":13679.4,"90th_percentile":23974.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1651.0,"10th_percentile":1651.0,"90th_percentile":1651.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":4926.4,"10th_percentile":4926.4,"90th_percentile":4926.4,"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":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24714.8,"10th_percentile":24714.8,"90th_percentile":24714.8,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":6003.59,"10th_percentile":6003.59,"90th_percentile":6003.59,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"24","median_amount":2634.82,"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":"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":8122.0,"10th_percentile":6949.89,"90th_percentile":9274.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4333.35,"10th_percentile":4333.35,"90th_percentile":4333.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":2529.64,"10th_percentile":2529.64,"90th_percentile":2529.64,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1405.25,"10th_percentile":1295.02,"90th_percentile":1516.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6121.08,"10th_percentile":3169.0,"90th_percentile":8816.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1521.14,"10th_percentile":1521.14,"90th_percentile":1521.14,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8413.3,"10th_percentile":6706.03,"90th_percentile":8619.1,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4924.69,"10th_percentile":4924.69,"90th_percentile":6621.5,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3320.53,"10th_percentile":3320.53,"90th_percentile":3325.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17378.58,"10th_percentile":13979.88,"90th_percentile":27348.34,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"14","median_amount":22198.68,"10th_percentile":18634.64,"90th_percentile":25153.5,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":3283.13,"10th_percentile":1672.02,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3144.0,"10th_percentile":3144.0,"90th_percentile":3144.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"53","median_amount":19223.7,"10th_percentile":11684.68,"90th_percentile":26194.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6924.75,"10th_percentile":5008.15,"90th_percentile":9246.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2750.33,"10th_percentile":2750.33,"90th_percentile":2750.33,"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":"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":5862.7,"10th_percentile":5862.7,"90th_percentile":5862.7,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3316.03,"10th_percentile":3316.03,"90th_percentile":3316.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3226.75,"10th_percentile":3226.75,"90th_percentile":3226.75,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3657.75,"10th_percentile":2555.79,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2246.5,"10th_percentile":2246.5,"90th_percentile":2246.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5020.0,"10th_percentile":3391.85,"90th_percentile":7530.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7476.0,"10th_percentile":7476.0,"90th_percentile":7476.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3318.03,"10th_percentile":3318.03,"90th_percentile":3318.03,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":8704.6,"10th_percentile":8148.3,"90th_percentile":9478.83,"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":"[Outpatient Services: Payer leverages 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."},{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5537.34,"10th_percentile":5537.34,"90th_percentile":5537.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"11","median_amount":51428.39,"10th_percentile":29580.56,"90th_percentile":64077.65,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":32312.14,"10th_percentile":23774.15,"90th_percentile":67323.96,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":4874.01,"10th_percentile":2492.42,"90th_percentile":7156.31,"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":6053.22,"10th_percentile":6053.22,"90th_percentile":6053.22,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"35","median_amount":37356.96,"10th_percentile":22947.62,"90th_percentile":69335.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8670.2,"10th_percentile":6808.2,"90th_percentile":18346.73},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":6515.59,"10th_percentile":6515.59,"90th_percentile":6515.59,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6046.27,"10th_percentile":5761.27,"90th_percentile":6051.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4679.45,"10th_percentile":4679.45,"90th_percentile":4874.01,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"12","median_amount":6734.0,"10th_percentile":5020.0,"90th_percentile":8421.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6686.0,"10th_percentile":6686.0,"90th_percentile":8753.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6047.97,"10th_percentile":6047.97,"90th_percentile":6047.97,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":46419.95,"10th_percentile":46419.95,"90th_percentile":46419.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1300.98,"10th_percentile":1300.98,"90th_percentile":1300.98,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":729.05,"10th_percentile":634.18,"90th_percentile":2064.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3017.0,"10th_percentile":3017.0,"90th_percentile":3017.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":3830.9,"10th_percentile":3017.0,"90th_percentile":18436.9,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1201.14,"10th_percentile":925.62,"90th_percentile":1980.05,"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":631.6,"10th_percentile":594.01,"90th_percentile":1586.11,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"18","median_amount":3335.0,"10th_percentile":2583.83,"90th_percentile":20334.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"17","median_amount":631.6,"10th_percentile":484.6,"90th_percentile":1646.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3017.0,"10th_percentile":3017.0,"90th_percentile":3017.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":639.51,"10th_percentile":631.61,"90th_percentile":645.14,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":7734.52,"10th_percentile":7734.52,"90th_percentile":7734.52,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1591.81,"10th_percentile":1514.34,"90th_percentile":1673.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7381.09,"10th_percentile":7381.09,"90th_percentile":15034.86,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":4577.0,"10th_percentile":4432.0,"90th_percentile":15191.28,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2159.84,"10th_percentile":925.62,"90th_percentile":3459.75,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1586.95,"10th_percentile":1586.95,"90th_percentile":1594.45,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"19","median_amount":4633.0,"10th_percentile":3769.9,"90th_percentile":18987.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1312.5,"10th_percentile":1274.35,"90th_percentile":3833.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1589.95,"10th_percentile":1465.45,"90th_percentile":1778.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":1251.08,"10th_percentile":1251.08,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"11","median_amount":3748.0,"10th_percentile":2824.31,"90th_percentile":4164.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4134.0,"10th_percentile":4134.0,"90th_percentile":4134.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1594.86,"10th_percentile":1591.66,"90th_percentile":1762.1,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1707.66,"10th_percentile":1707.66,"90th_percentile":1707.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"14","median_amount":7022.53,"10th_percentile":5249.63,"90th_percentile":8341.65,"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":"1 through 10","median_amount":3841.9,"10th_percentile":3841.9,"90th_percentile":6025.36,"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 ($): FEE SCHEDULE]","count":"20","median_amount":3215.4,"10th_percentile":2872.4,"90th_percentile":3366.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"15","median_amount":14379.03,"10th_percentile":12045.44,"90th_percentile":38980.35,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"32","median_amount":14855.02,"10th_percentile":12552.17,"90th_percentile":23340.69,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2660.97,"10th_percentile":2291.32,"90th_percentile":5784.82,"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":"12","median_amount":3215.4,"10th_percentile":3013.95,"90th_percentile":3222.9,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3051.35,"10th_percentile":3051.35,"90th_percentile":3226.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"78","median_amount":14344.28,"10th_percentile":12328.77,"90th_percentile":35338.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":4356.94,"10th_percentile":4237.59,"90th_percentile":4947.81},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3043.9,"10th_percentile":3043.9,"90th_percentile":3043.9,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"43","median_amount":3215.4,"10th_percentile":3068.4,"90th_percentile":3223.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3131.67,"10th_percentile":3131.67,"90th_percentile":5698.11,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3418.98,"10th_percentile":3240.65,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2845.5,"10th_percentile":2845.5,"90th_percentile":2845.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2714.19,"10th_percentile":2714.19,"90th_percentile":2714.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"18","median_amount":5822.0,"10th_percentile":5558.0,"90th_percentile":7406.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5780.0,"10th_percentile":5780.0,"90th_percentile":5780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":3215.4,"10th_percentile":3013.96,"90th_percentile":3220.4,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3738.83,"10th_percentile":3738.83,"90th_percentile":3738.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8623.08,"10th_percentile":8623.08,"90th_percentile":9111.08,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5527.31,"10th_percentile":5527.31,"90th_percentile":5527.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":35018.52,"10th_percentile":35018.52,"90th_percentile":55613.56,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":31868.13,"10th_percentile":27336.72,"90th_percentile":48187.14,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":6025.36,"10th_percentile":4441.95,"90th_percentile":7130.42,"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":"1 through 10","median_amount":5277.31,"10th_percentile":5277.31,"90th_percentile":5277.31,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":32924.72,"10th_percentile":26269.2,"90th_percentile":46036.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5196.17,"10th_percentile":5196.17,"90th_percentile":5196.17,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5522.31,"10th_percentile":5134.31,"90th_percentile":5532.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4784.53,"10th_percentile":4784.53,"90th_percentile":4784.53,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9112.5,"10th_percentile":9112.5,"90th_percentile":9112.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5399.7,"10th_percentile":5135.21,"90th_percentile":5529.92,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"23","median_amount":8565.67,"10th_percentile":7189.95,"90th_percentile":8983.16,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4089.35,"10th_percentile":4089.35,"90th_percentile":4089.35,"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 ($): FEE SCHEDULE]","count":"58","median_amount":3292.79,"10th_percentile":2948.29,"90th_percentile":3299.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4659.61,"10th_percentile":4659.61,"90th_percentile":4659.61,"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":"Choice Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"25","median_amount":25434.45,"10th_percentile":23548.75,"90th_percentile":45234.93,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"36","median_amount":25363.71,"10th_percentile":24033.11,"90th_percentile":28483.85,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":3029.45,"10th_percentile":2908.52,"90th_percentile":4421.3,"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":"31","median_amount":3286.79,"10th_percentile":3187.79,"90th_percentile":3507.15,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3379.51,"10th_percentile":3118.15,"90th_percentile":3379.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"129","median_amount":25678.62,"10th_percentile":21447.13,"90th_percentile":35815.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7676.95,"10th_percentile":7576.1,"90th_percentile":8415.26},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3290.59,"10th_percentile":3289.29,"90th_percentile":3292.29,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2962.22,"10th_percentile":2962.22,"90th_percentile":2962.22,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"123","median_amount":3238.79,"10th_percentile":3029.45,"90th_percentile":3438.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2977.41,"10th_percentile":2856.48,"90th_percentile":4519.82,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4467.03,"10th_percentile":4467.03,"90th_percentile":4467.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"21","median_amount":6734.0,"10th_percentile":5187.2,"90th_percentile":7559.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6686.0,"10th_percentile":5529.88,"90th_percentile":7505.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":3285.8,"10th_percentile":2898.7,"90th_percentile":4659.61,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8803.73,"10th_percentile":8803.73,"90th_percentile":8803.73,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5842.34,"10th_percentile":5832.01,"90th_percentile":5853.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38657.75,"10th_percentile":38657.75,"90th_percentile":38657.75,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":47782.35,"10th_percentile":47782.35,"90th_percentile":94898.11,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":9766.16,"10th_percentile":9766.16,"90th_percentile":9766.16,"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":"1 through 10","median_amount":5824.51,"10th_percentile":5824.51,"90th_percentile":5829.51,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":52781.2,"10th_percentile":36663.15,"90th_percentile":76096.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":433.65,"10th_percentile":433.65,"90th_percentile":433.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5832.41,"10th_percentile":5832.41,"90th_percentile":5832.41,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"13","median_amount":5824.51,"10th_percentile":5677.51,"90th_percentile":14650.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7528.0,"10th_percentile":7528.0,"90th_percentile":7528.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":16165.13,"10th_percentile":16165.13,"90th_percentile":16165.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5829.52,"10th_percentile":5594.22,"90th_percentile":11590.21,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"20","median_amount":10313.64,"10th_percentile":8805.56,"90th_percentile":18914.62,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"30","median_amount":11590.21,"10th_percentile":10426.55,"90th_percentile":16296.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"22","median_amount":67213.29,"10th_percentile":56670.12,"90th_percentile":125931.09,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"38","median_amount":71357.09,"10th_percentile":58093.4,"90th_percentile":140548.86,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":10297.95,"10th_percentile":9886.86,"90th_percentile":15895.61,"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":11585.21,"10th_percentile":8.31,"90th_percentile":18344.07,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11297.64,"10th_percentile":10994.13,"90th_percentile":11892.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"89","median_amount":82297.98,"10th_percentile":57218.48,"90th_percentile":117501.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":29576.41,"10th_percentile":27107.22,"90th_percentile":32500.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11593.11,"10th_percentile":11593.11,"90th_percentile":11593.11,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"139","median_amount":11588.21,"10th_percentile":10602.19,"90th_percentile":11683.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11291.2,"10th_percentile":10266.72,"90th_percentile":15659.05,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"19","median_amount":12218.95,"10th_percentile":8847.0,"90th_percentile":30093.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9502.18,"10th_percentile":9502.18,"90th_percentile":17030.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":11585.21,"10th_percentile":11198.11,"90th_percentile":11612.37,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11858.17,"10th_percentile":11858.17,"90th_percentile":11858.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":29949.5,"10th_percentile":9697.68,"90th_percentile":37837.15,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18344.07,"10th_percentile":18344.07,"90th_percentile":18344.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":216032.17,"10th_percentile":216032.17,"90th_percentile":216032.17,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":90004.37,"10th_percentile":88152.56,"90th_percentile":150015.05,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":10721.23,"10th_percentile":10577.67,"90th_percentile":14779.12,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18362.21,"10th_percentile":18346.07,"90th_percentile":22734.82,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"14","median_amount":105898.36,"10th_percentile":78764.54,"90th_percentile":186640.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":32018.01,"10th_percentile":32018.01,"90th_percentile":32018.01},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18347.57,"10th_percentile":18347.57,"90th_percentile":18351.56,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"17","median_amount":18344.07,"10th_percentile":18197.07,"90th_percentile":18361.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":23905.88,"10th_percentile":23905.88,"90th_percentile":23905.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":18199.69,"10th_percentile":14675.26,"90th_percentile":18517.17,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":29041.57,"10th_percentile":29041.57,"90th_percentile":29041.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":190334.99,"10th_percentile":190334.99,"90th_percentile":190334.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":28894.57,"10th_percentile":28894.57,"90th_percentile":29041.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 1 Electrophysiologic Procedures","code_information":[{"code":"5211","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1242.18,"10th_percentile":1242.18,"90th_percentile":1242.18,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7775.27,"10th_percentile":7775.27,"90th_percentile":7775.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":96741.65,"10th_percentile":96741.65,"90th_percentile":96741.65,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":78068.52,"10th_percentile":78068.52,"90th_percentile":78068.52,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":45.95,"10th_percentile":45.95,"90th_percentile":45.95,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7754.79,"10th_percentile":7754.79,"90th_percentile":7754.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7549.93,"10th_percentile":7549.93,"90th_percentile":7549.93,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7622.02,"10th_percentile":7622.02,"90th_percentile":8089.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9141.91,"10th_percentile":9141.91,"90th_percentile":9141.91,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"11","median_amount":8749.22,"10th_percentile":8364.89,"90th_percentile":40916.74,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"24","median_amount":25069.04,"10th_percentile":25061.5,"90th_percentile":25077.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":128520.85,"10th_percentile":124429.3,"90th_percentile":257182.98,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"11","median_amount":203188.59,"10th_percentile":188969.82,"90th_percentile":228571.34,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":21947.71,"10th_percentile":21079.37,"90th_percentile":31607.34,"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":25070.41,"10th_percentile":25063.5,"90th_percentile":25086.27,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21311.58,"10th_percentile":21311.58,"90th_percentile":21311.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"51","median_amount":203585.0,"10th_percentile":122370.04,"90th_percentile":230164.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":28142.16,"10th_percentile":26480.86,"90th_percentile":32156.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":24897.91,"10th_percentile":24897.91,"90th_percentile":24897.91,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"29","median_amount":25074.28,"10th_percentile":24673.51,"90th_percentile":25077.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9704.5,"10th_percentile":8474.6,"90th_percentile":9704.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9634.5,"10th_percentile":9634.5,"90th_percentile":9634.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":25069.42,"10th_percentile":25063.51,"90th_percentile":25077.02,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":14029.55,"10th_percentile":14029.55,"90th_percentile":14029.55,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8461.2,"10th_percentile":8461.2,"90th_percentile":8461.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":45207.0,"10th_percentile":45207.0,"90th_percentile":45298.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":12917.93,"10th_percentile":12917.93,"90th_percentile":13177.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8454.51,"10th_percentile":8454.51,"90th_percentile":8454.51,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":45164.0,"10th_percentile":44527.93,"90th_percentile":52465.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8454.51,"10th_percentile":8418.51,"90th_percentile":8462.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8234.35,"10th_percentile":8234.35,"90th_percentile":8234.35,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":22093.0,"10th_percentile":22093.0,"90th_percentile":22093.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6763.61,"10th_percentile":6763.61,"90th_percentile":6763.61,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10698.99,"10th_percentile":10691.08,"90th_percentile":11028.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":55352.32,"10th_percentile":55352.32,"90th_percentile":55352.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":11919.86,"10th_percentile":11919.86,"90th_percentile":11919.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10612.81,"10th_percentile":10612.81,"90th_percentile":10691.08,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":52046.22,"10th_percentile":48946.47,"90th_percentile":124588.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":18586.29,"10th_percentile":18586.29,"90th_percentile":18586.29},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10694.58,"10th_percentile":10694.58,"90th_percentile":10709.43,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"18","median_amount":10691.08,"10th_percentile":10299.08,"90th_percentile":10706.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10699.0,"10th_percentile":10691.49,"90th_percentile":19490.46,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19482.56,"10th_percentile":19482.56,"90th_percentile":19498.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19482.56,"10th_percentile":19482.56,"90th_percentile":19482.56,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19485.56,"10th_percentile":19485.56,"90th_percentile":19909.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19506.84,"10th_percentile":19506.84,"90th_percentile":19506.84,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":37532.39,"10th_percentile":37532.39,"90th_percentile":37532.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22935.39,"10th_percentile":22935.39,"90th_percentile":22935.39,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":123978.53,"10th_percentile":121146.09,"90th_percentile":126807.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22783.39,"10th_percentile":22783.39,"90th_percentile":23030.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22930.8,"10th_percentile":22930.8,"90th_percentile":22930.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":29116.07,"10th_percentile":29116.07,"90th_percentile":53474.61,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32753.2,"10th_percentile":32753.2,"90th_percentile":32761.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":163743.67,"10th_percentile":163743.67,"90th_percentile":201031.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":40250.04,"10th_percentile":40250.04,"90th_percentile":41771.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32780.53,"10th_percentile":32780.53,"90th_percentile":32780.53,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31082.12,"10th_percentile":31082.12,"90th_percentile":31082.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":170733.86,"10th_percentile":158200.87,"90th_percentile":238926.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":79986.65,"10th_percentile":79986.65,"90th_percentile":79986.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32756.7,"10th_percentile":32756.7,"90th_percentile":32756.7,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32711.15,"10th_percentile":32606.2,"90th_percentile":32765.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":27650.5,"10th_percentile":27650.5,"90th_percentile":27650.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":29921.28,"10th_percentile":29921.28,"90th_percentile":29921.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":32715.7,"10th_percentile":26202.56,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1730.58,"10th_percentile":1730.58,"90th_percentile":1730.58,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2893.9,"10th_percentile":2893.9,"90th_percentile":2893.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2074.08,"10th_percentile":1834.28,"90th_percentile":2561.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4693.0,"10th_percentile":4693.0,"90th_percentile":4693.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":9774.0,"10th_percentile":3082.0,"90th_percentile":35959.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2141.47,"10th_percentile":2141.47,"90th_percentile":2141.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3769.53,"10th_percentile":3769.53,"90th_percentile":3769.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1963.23,"10th_percentile":1963.23,"90th_percentile":2791.79,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1992.1,"10th_percentile":1748.4,"90th_percentile":3814.16,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"65","median_amount":957.78,"10th_percentile":857.13,"90th_percentile":960.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6531.42,"10th_percentile":6531.42,"90th_percentile":6531.42,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"21","median_amount":6370.0,"10th_percentile":3414.0,"90th_percentile":8633.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"88","median_amount":1020.88,"10th_percentile":869.88,"90th_percentile":1063.33,"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":"1 through 10","median_amount":963.78,"10th_percentile":963.78,"90th_percentile":2065.44,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"85","median_amount":6370.0,"10th_percentile":2914.0,"90th_percentile":10234.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1783.6,"10th_percentile":1299.76,"90th_percentile":4140.85},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1190.15,"10th_percentile":1190.15,"90th_percentile":1190.15,"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":"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":121.28,"10th_percentile":121.28,"90th_percentile":2305.88,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"29","median_amount":959.74,"10th_percentile":663.78,"90th_percentile":2037.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":499.4,"10th_percentile":499.4,"90th_percentile":499.4,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2914.0,"10th_percentile":2914.0,"90th_percentile":4164.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3100.5,"10th_percentile":3100.5,"90th_percentile":3100.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":957.79,"10th_percentile":570.69,"90th_percentile":1273.26,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1691.62,"10th_percentile":1691.62,"90th_percentile":2023.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1937.91,"10th_percentile":1906.7,"90th_percentile":3690.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":59520.13,"10th_percentile":13311.44,"90th_percentile":59520.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":11879.86,"10th_percentile":9903.44,"90th_percentile":48826.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1570.41,"10th_percentile":1570.41,"90th_percentile":1570.41,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1839.04,"10th_percentile":1839.04,"90th_percentile":1839.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":15308.36,"10th_percentile":11104.28,"90th_percentile":28735.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5291.65,"10th_percentile":5291.65,"90th_percentile":5291.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":906.05,"10th_percentile":906.05,"90th_percentile":906.05,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1937.91,"10th_percentile":1937.91,"90th_percentile":1937.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2053.61,"10th_percentile":2053.61,"90th_percentile":2053.61,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4953.5,"10th_percentile":4953.5,"90th_percentile":4953.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9058.27,"10th_percentile":9058.27,"90th_percentile":9058.27,"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":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":31381.66,"10th_percentile":31381.66,"90th_percentile":31381.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":27624.84,"10th_percentile":27624.84,"90th_percentile":27624.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3092.07,"10th_percentile":520.61,"90th_percentile":10099.29,"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":763.91,"10th_percentile":763.91,"90th_percentile":763.91,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":931.37,"10th_percentile":931.37,"90th_percentile":931.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":7409.0,"10th_percentile":7409.0,"90th_percentile":47200.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":382.17,"10th_percentile":382.17,"90th_percentile":1806.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"15","median_amount":14000.77,"10th_percentile":7671.23,"90th_percentile":31482.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6872.95,"10th_percentile":6872.95,"90th_percentile":6872.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":382.17,"10th_percentile":382.17,"90th_percentile":382.17,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":934.37,"10th_percentile":934.37,"90th_percentile":934.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":325.15,"10th_percentile":325.15,"90th_percentile":325.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1497.0,"10th_percentile":973.0,"90th_percentile":2701.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9072.66,"10th_percentile":9072.66,"90th_percentile":9072.66,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2340.38,"10th_percentile":2340.38,"90th_percentile":2340.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":17618.17,"10th_percentile":17618.17,"90th_percentile":17618.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":17538.79,"10th_percentile":9053.64,"90th_percentile":34411.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6745.55,"10th_percentile":6745.55,"90th_percentile":6745.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3939.0,"10th_percentile":3939.0,"90th_percentile":3939.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8593.63,"10th_percentile":8451.71,"90th_percentile":31126.47,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2810.12,"10th_percentile":2810.12,"90th_percentile":2978.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16149.02,"10th_percentile":16018.42,"90th_percentile":25094.33,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":23038.37,"10th_percentile":19825.32,"90th_percentile":42789.43,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1895.07,"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":2807.89,"10th_percentile":2807.89,"90th_percentile":2807.89,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"36","median_amount":20349.77,"10th_percentile":15314.16,"90th_percentile":27916.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5982.2,"10th_percentile":5982.2,"90th_percentile":5982.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2360.93,"10th_percentile":2360.93,"90th_percentile":2360.93,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2804.55,"10th_percentile":2664.33,"90th_percentile":5526.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7102.0,"10th_percentile":4984.0,"90th_percentile":7530.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4984.0,"10th_percentile":4984.0,"90th_percentile":7051.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2809.45,"10th_percentile":2809.05,"90th_percentile":3109.6,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":9134.13,"10th_percentile":4886.02,"90th_percentile":11771.87,"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":"1 through 10","median_amount":5206.43,"10th_percentile":5206.43,"90th_percentile":5206.43,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3612.18,"10th_percentile":3605.18,"90th_percentile":3680.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":19414.08,"10th_percentile":12144.25,"90th_percentile":47258.15,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"18","median_amount":24636.96,"10th_percentile":17016.79,"90th_percentile":49218.73,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":15095.79,"10th_percentile":15095.79,"90th_percentile":15095.79},{"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":"20","median_amount":4425.0,"10th_percentile":2125.75,"90th_percentile":6693.06,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3605.18,"10th_percentile":3360.18,"90th_percentile":3611.18,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3421.25,"10th_percentile":3421.25,"90th_percentile":3421.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"65","median_amount":21770.95,"10th_percentile":15551.93,"90th_percentile":36951.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":7468.17,"10th_percentile":5579.29,"90th_percentile":9353.52},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":5201.7,"90th_percentile":5201.7,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"25","median_amount":3608.18,"10th_percentile":3458.18,"90th_percentile":3798.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2674.09,"10th_percentile":2674.09,"90th_percentile":2674.09,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4922.3,"10th_percentile":4922.3,"90th_percentile":4922.3,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5334.2,"10th_percentile":4623.87,"90th_percentile":9234.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5780.0,"10th_percentile":5780.0,"90th_percentile":5780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":3613.09,"10th_percentile":3360.19,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.71,"10th_percentile":120.71,"90th_percentile":120.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6381.76,"10th_percentile":6381.76,"90th_percentile":6392.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":52164.74,"10th_percentile":52164.74,"90th_percentile":52164.74,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":29930.15,"10th_percentile":26931.85,"90th_percentile":64098.62,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":5417.98,"10th_percentile":5417.98,"90th_percentile":7650.29,"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":"1 through 10","median_amount":6560.56,"10th_percentile":6560.56,"90th_percentile":6560.56,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":42161.04,"10th_percentile":39239.0,"90th_percentile":51011.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":2968.47,"10th_percentile":2968.47,"90th_percentile":2968.47,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6377.64,"10th_percentile":6377.64,"90th_percentile":6377.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":11628.35,"10th_percentile":11628.35,"90th_percentile":11628.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5780.0,"10th_percentile":5780.0,"90th_percentile":5780.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6382.26,"10th_percentile":6382.26,"90th_percentile":6382.26,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"103","median_amount":8732.16,"10th_percentile":7103.0,"90th_percentile":15172.26,"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":"12","median_amount":5319.87,"10th_percentile":4314.86,"90th_percentile":6291.08,"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 ($): FEE SCHEDULE]","count":"29","median_amount":5968.9,"10th_percentile":5717.21,"90th_percentile":6152.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4768.16,"10th_percentile":4768.16,"90th_percentile":4768.16,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"82","median_amount":40614.71,"10th_percentile":24942.42,"90th_percentile":59780.38,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"116","median_amount":36548.96,"10th_percentile":26109.81,"90th_percentile":53422.69,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"157","median_amount":5684.09,"10th_percentile":4311.64,"90th_percentile":7979.8,"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":5960.94,"10th_percentile":5637.76,"90th_percentile":6090.21,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5656.12,"10th_percentile":5656.12,"90th_percentile":10093.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"526","median_amount":37519.08,"10th_percentile":25230.27,"90th_percentile":59128.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"57","median_amount":9594.91,"10th_percentile":6802.7,"90th_percentile":16485.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5641.95,"10th_percentile":5641.95,"90th_percentile":5788.71,"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":"[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":6041.69,"10th_percentile":4425.0,"90th_percentile":7206.62,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"68","median_amount":5963.21,"10th_percentile":5651.06,"90th_percentile":6137.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":5544.14,"10th_percentile":4425.0,"90th_percentile":7979.8,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6812.47,"10th_percentile":6812.47,"90th_percentile":6920.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"87","median_amount":7528.0,"10th_percentile":6022.4,"90th_percentile":11292.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"20","median_amount":7474.0,"10th_percentile":5994.96,"90th_percentile":11211.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":5965.57,"10th_percentile":5136.95,"90th_percentile":6269.17,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"32","median_amount":9102.6,"10th_percentile":8280.44,"90th_percentile":10320.42,"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":"1 through 10","median_amount":959.35,"10th_percentile":959.35,"90th_percentile":959.35,"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 ($): FEE SCHEDULE]","count":"21","median_amount":10641.53,"10th_percentile":10293.09,"90th_percentile":10655.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"29","median_amount":70416.97,"10th_percentile":47123.92,"90th_percentile":87918.21,"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":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"63","median_amount":66577.84,"10th_percentile":42632.45,"90th_percentile":85763.69,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"30","median_amount":6717.68,"10th_percentile":921.05,"90th_percentile":9982.67,"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":"1 through 10","median_amount":10635.8,"10th_percentile":10341.8,"90th_percentile":10818.57,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10093.16,"10th_percentile":10093.16,"90th_percentile":10093.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"156","median_amount":65625.67,"10th_percentile":45468.42,"90th_percentile":87455.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"16","median_amount":17793.69,"10th_percentile":14919.45,"90th_percentile":22164.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10464.3,"10th_percentile":2001.4,"90th_percentile":10614.8,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"27","median_amount":10488.8,"10th_percentile":912.5,"90th_percentile":10729.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9799.39,"10th_percentile":9799.39,"90th_percentile":9799.39,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9602.97,"10th_percentile":9602.97,"90th_percentile":9602.97,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":978.54,"10th_percentile":978.54,"90th_percentile":978.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"35","median_amount":7528.0,"10th_percentile":6022.4,"90th_percentile":15736.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":7483.28,"10th_percentile":7483.28,"90th_percentile":12521.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":10635.81,"10th_percentile":1999.6,"90th_percentile":10644.05,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":697.77,"10th_percentile":697.77,"90th_percentile":697.77,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1186.0,"10th_percentile":1186.0,"90th_percentile":1475.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":2219.0,"10th_percentile":20.0,"90th_percentile":2219.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":410.84,"10th_percentile":106.84,"90th_percentile":1838.7,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"75","median_amount":1284.0,"10th_percentile":1186.0,"90th_percentile":2340.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"14","median_amount":1090.0,"10th_percentile":773.9,"90th_percentile":1573.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3379.45,"10th_percentile":3379.45,"90th_percentile":3379.45,"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 ($): FEE SCHEDULE]","count":"38","median_amount":683.86,"10th_percentile":645.92,"90th_percentile":689.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"20","median_amount":5722.0,"10th_percentile":4805.0,"90th_percentile":5830.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":5192.0,"10th_percentile":5192.0,"90th_percentile":5437.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":506.73,"10th_percentile":452.45,"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":"1 through 10","median_amount":683.86,"10th_percentile":681.86,"90th_percentile":689.36,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"107","median_amount":5722.0,"10th_percentile":4903.0,"90th_percentile":5731.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1955.3,"10th_percentile":1216.33,"90th_percentile":2002.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":685.36,"10th_percentile":685.36,"90th_percentile":685.36,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"54","median_amount":681.86,"10th_percentile":645.92,"90th_percentile":683.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":661.41,"10th_percentile":661.41,"90th_percentile":661.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"24","median_amount":3491.06,"10th_percentile":2155.32,"90th_percentile":3491.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3491.06,"10th_percentile":3491.06,"90th_percentile":3491.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":646.92,"10th_percentile":570.49,"90th_percentile":682.87,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8269.32,"10th_percentile":5904.6,"90th_percentile":8714.02,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"12","median_amount":2092.7,"10th_percentile":1725.2,"90th_percentile":2097.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":17419.62,"10th_percentile":14549.44,"90th_percentile":31172.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":23996.72,"10th_percentile":14493.09,"90th_percentile":63699.88,"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":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1877.25,"10th_percentile":1660.28,"90th_percentile":2376.13,"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":"1 through 10","median_amount":2093.43,"10th_percentile":1987.27,"90th_percentile":2108.05,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1985.93,"10th_percentile":1985.93,"90th_percentile":1985.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"33","median_amount":16468.32,"10th_percentile":12808.13,"90th_percentile":22626.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5363.56,"10th_percentile":5363.56,"90th_percentile":5363.56},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2172.09,"10th_percentile":2172.09,"90th_percentile":3529.87,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2474.93,"10th_percentile":2474.93,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"32","median_amount":2095.7,"10th_percentile":1945.7,"90th_percentile":2165.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1732.16,"10th_percentile":1623.94,"90th_percentile":3688.22,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2524.43,"10th_percentile":2524.43,"90th_percentile":2524.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4164.0,"10th_percentile":4016.0,"90th_percentile":5020.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4134.0,"10th_percentile":4134.0,"90th_percentile":4134.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":2092.71,"10th_percentile":1852.61,"90th_percentile":2100.21,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":8677.18,"10th_percentile":7946.8,"90th_percentile":13617.2,"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":3547.18,"10th_percentile":3547.18,"90th_percentile":3547.18,"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 ($): FEE SCHEDULE]","count":"20","median_amount":3527.07,"10th_percentile":3155.87,"90th_percentile":3534.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":22200.33,"10th_percentile":19635.17,"90th_percentile":38652.49,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"24","median_amount":22505.0,"10th_percentile":16313.01,"90th_percentile":33653.78,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":32721.03,"10th_percentile":32721.03,"90th_percentile":32721.03},{"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":2230.5,"10th_percentile":1955.3,"90th_percentile":3659.05,"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":3449.62,"10th_percentile":3296.36,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3343.61,"10th_percentile":3343.61,"90th_percentile":3511.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"86","median_amount":24713.82,"10th_percentile":18228.5,"90th_percentile":42421.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"16","median_amount":8603.8,"10th_percentile":4913.3,"90th_percentile":13001.03},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3529.87,"10th_percentile":3529.87,"90th_percentile":3529.87,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3324.35,"10th_percentile":3324.35,"90th_percentile":3324.35,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"46","median_amount":3526.37,"10th_percentile":3250.37,"90th_percentile":3586.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2358.94,"10th_percentile":2358.94,"90th_percentile":2557.98,"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":"1 through 10","median_amount":1955.3,"10th_percentile":1955.3,"90th_percentile":3250.2,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"21","median_amount":6888.67,"10th_percentile":4258.9,"90th_percentile":10081.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5140.0,"10th_percentile":4792.0,"90th_percentile":7211.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":3523.38,"10th_percentile":3304.26,"90th_percentile":3530.88,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"25","median_amount":8435.67,"10th_percentile":7607.42,"90th_percentile":8752.17,"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":6072.4,"10th_percentile":6072.4,"90th_percentile":6072.4,"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 ($): FEE SCHEDULE]","count":"26","median_amount":5200.28,"10th_percentile":5189.08,"90th_percentile":5800.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"13","median_amount":30873.68,"10th_percentile":23234.52,"90th_percentile":41690.2,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"33","median_amount":34270.89,"10th_percentile":24959.8,"90th_percentile":44376.2,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":32224.12,"10th_percentile":32224.12,"90th_percentile":32224.12},{"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":"24","median_amount":5526.29,"10th_percentile":3415.6,"90th_percentile":7008.18,"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":5193.28,"10th_percentile":4897.64,"90th_percentile":5201.35,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4928.79,"10th_percentile":4928.79,"90th_percentile":4928.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"127","median_amount":32673.26,"10th_percentile":24011.38,"90th_percentile":46121.28,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"11","median_amount":10781.17,"10th_percentile":7193.9,"90th_percentile":12487.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5193.28,"10th_percentile":5193.28,"90th_percentile":5199.78,"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":"1 through 10","median_amount":4888.28,"10th_percentile":4888.28,"90th_percentile":4888.28,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4776.78,"10th_percentile":4776.78,"90th_percentile":4776.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":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 ($): FEE SCHEDULE]","count":"57","median_amount":5196.28,"10th_percentile":4895.64,"90th_percentile":5257.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5609.66,"10th_percentile":5058.05,"90th_percentile":5612.95,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5705.75,"10th_percentile":5705.75,"90th_percentile":6394.24,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":5819.86,"10th_percentile":5819.86,"90th_percentile":5819.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"25","median_amount":6734.0,"10th_percentile":6734.0,"90th_percentile":11795.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6686.0,"10th_percentile":6017.4,"90th_percentile":11747.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":5193.29,"10th_percentile":4963.73,"90th_percentile":5575.79,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3115.97,"10th_percentile":3115.97,"90th_percentile":3115.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9454.12,"10th_percentile":9454.12,"90th_percentile":9478.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":57382.05,"10th_percentile":57382.05,"90th_percentile":68827.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1853.94,"10th_percentile":1853.94,"90th_percentile":1853.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8710.76,"10th_percentile":8710.76,"90th_percentile":8710.76,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":52287.96,"10th_percentile":51803.61,"90th_percentile":58366.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"12","median_amount":9449.62,"10th_percentile":9254.04,"90th_percentile":9508.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":9244.0,"10th_percentile":9244.0,"90th_percentile":9244.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9451.63,"10th_percentile":9451.63,"90th_percentile":9454.13,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13280.19,"10th_percentile":13280.19,"90th_percentile":13280.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":98942.23,"10th_percentile":98942.23,"90th_percentile":98942.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":99185.6,"10th_percentile":99185.6,"90th_percentile":99185.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":77582.83,"10th_percentile":77582.83,"90th_percentile":77582.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13272.69,"10th_percentile":13272.69,"90th_percentile":13272.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20567.76,"10th_percentile":20567.76,"90th_percentile":20570.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":142459.36,"10th_percentile":142459.36,"90th_percentile":142459.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":110719.02,"10th_percentile":92974.19,"90th_percentile":191641.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20568.76,"10th_percentile":20568.76,"90th_percentile":20568.76,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":129806.9,"10th_percentile":88637.8,"90th_percentile":178500.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34339.72,"10th_percentile":34339.72,"90th_percentile":34339.72},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20562.76,"10th_percentile":20490.76,"90th_percentile":20646.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20195.57,"10th_percentile":20195.57,"90th_percentile":20195.57,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2887.9,"10th_percentile":2690.39,"90th_percentile":3831.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":84619.46,"10th_percentile":84619.46,"90th_percentile":84619.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1745.92,"10th_percentile":1745.92,"90th_percentile":1745.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2950.97,"10th_percentile":2950.97,"90th_percentile":2950.97,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2922.45,"10th_percentile":2922.45,"90th_percentile":2922.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":31277.22,"10th_percentile":31277.22,"90th_percentile":31277.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":129.09,"10th_percentile":129.09,"90th_percentile":129.09,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2959.13,"10th_percentile":2376.49,"90th_percentile":3202.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":4342.7,"10th_percentile":4342.7,"90th_percentile":4342.7,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3013.95,"10th_percentile":2887.9,"90th_percentile":4690.05,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"454","median_amount":1017.0,"10th_percentile":535.46,"90th_percentile":1459.15,"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":"81","median_amount":400.86,"10th_percentile":233.34,"90th_percentile":544.52,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":337.16,"10th_percentile":313.4,"90th_percentile":338.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":535.01,"10th_percentile":535.01,"90th_percentile":535.01,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"387","median_amount":1695.0,"10th_percentile":1605.5,"90th_percentile":2976.64,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"136","median_amount":40.0,"10th_percentile":20.0,"90th_percentile":400.86,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":2675.0,"10th_percentile":2675.0,"90th_percentile":2675.0},{"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":"1314","median_amount":243.04,"10th_percentile":233.34,"90th_percentile":544.52,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":337.16,"10th_percentile":337.16,"90th_percentile":337.16,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"2052","median_amount":1725.29,"10th_percentile":1608.56,"90th_percentile":3073.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"348","median_amount":593.25,"10th_percentile":504.26,"90th_percentile":1001.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"62","median_amount":460.62,"10th_percentile":243.04,"90th_percentile":544.52,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"40","median_amount":340.16,"10th_percentile":190.16,"90th_percentile":575.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":261.64,"10th_percentile":261.64,"90th_percentile":261.64,"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":"49","median_amount":512.95,"10th_percentile":268.91,"90th_percentile":615.58,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"48","median_amount":408.88,"10th_percentile":247.9,"90th_percentile":555.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":408.88,"10th_percentile":392.56,"90th_percentile":408.88,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"553","median_amount":1050.9,"10th_percentile":493.52,"90th_percentile":1453.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"60","median_amount":1050.9,"10th_percentile":493.52,"90th_percentile":1658.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":341.36,"10th_percentile":338.01,"90th_percentile":596.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":522.78,"10th_percentile":522.78,"90th_percentile":522.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":16566.55,"10th_percentile":16566.55,"90th_percentile":16566.55,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":27456.1,"10th_percentile":27456.1,"90th_percentile":27456.1,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":15106.37,"10th_percentile":15106.37,"90th_percentile":15106.37},{"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":391.04,"10th_percentile":360.84,"90th_percentile":412.43,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"12","median_amount":4246.56,"10th_percentile":3289.37,"90th_percentile":16449.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1429.7,"10th_percentile":1429.7,"90th_percentile":6015.69},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":399.86,"10th_percentile":399.86,"90th_percentile":399.86,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":300.24,"10th_percentile":300.24,"90th_percentile":300.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":723.0,"10th_percentile":723.0,"90th_percentile":723.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3048.0,"10th_percentile":3048.0,"90th_percentile":9135.51,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5129.0,"10th_percentile":5129.0,"90th_percentile":5129.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":7936.0,"10th_percentile":6014.0,"90th_percentile":21387.25,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":978.33,"10th_percentile":978.33,"90th_percentile":978.33,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"16","median_amount":6014.0,"10th_percentile":5129.0,"90th_percentile":9872.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1792.35,"10th_percentile":1792.35,"90th_percentile":1792.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":742.82,"10th_percentile":742.82,"90th_percentile":742.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3169.0,"10th_percentile":3169.0,"90th_percentile":3169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"57","median_amount":8233.06,"10th_percentile":4938.27,"90th_percentile":9222.55,"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":"1 through 10","median_amount":3813.63,"10th_percentile":3813.63,"90th_percentile":4891.58,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3253.85,"10th_percentile":3055.61,"90th_percentile":3262.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2865.59,"10th_percentile":2865.59,"90th_percentile":2865.59,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"55","median_amount":19616.44,"10th_percentile":14381.22,"90th_percentile":27402.44,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"83","median_amount":19680.86,"10th_percentile":13682.41,"90th_percentile":26661.89,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":2918.62,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3254.11,"10th_percentile":3248.85,"90th_percentile":3254.61,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3195.92,"10th_percentile":3195.92,"90th_percentile":3195.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"314","median_amount":19788.6,"10th_percentile":13421.18,"90th_percentile":26579.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"39","median_amount":5305.65,"10th_percentile":3426.55,"90th_percentile":7151.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":2171.47,"10th_percentile":2171.47,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"14","median_amount":3251.12,"10th_percentile":3076.12,"90th_percentile":3260.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2867.18,"10th_percentile":2867.18,"90th_percentile":2867.18,"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":"1 through 10","median_amount":2918.62,"10th_percentile":2918.62,"90th_percentile":6628.03,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2214.9,"10th_percentile":2214.9,"90th_percentile":2214.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"66","median_amount":5020.0,"10th_percentile":3816.0,"90th_percentile":5712.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4984.0,"10th_percentile":4178.85,"90th_percentile":5275.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3248.13,"10th_percentile":2861.52,"90th_percentile":3265.53,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"21","median_amount":8446.17,"10th_percentile":6853.88,"90th_percentile":9248.59,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5043.27,"10th_percentile":4699.93,"90th_percentile":5050.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"18","median_amount":24989.49,"10th_percentile":18658.64,"90th_percentile":45150.73,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"23","median_amount":27628.14,"10th_percentile":22122.95,"90th_percentile":33319.89,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":5168.72,"10th_percentile":2918.62,"90th_percentile":7062.46,"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":"1 through 10","median_amount":5048.67,"10th_percentile":5048.67,"90th_percentile":5051.17,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4785.97,"10th_percentile":4785.97,"90th_percentile":4785.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"106","median_amount":25919.44,"10th_percentile":19089.96,"90th_percentile":39006.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"14","median_amount":8707.86,"10th_percentile":5602.45,"90th_percentile":13748.79},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"12","median_amount":5045.93,"10th_percentile":4748.93,"90th_percentile":5050.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4911.94,"10th_percentile":4911.94,"90th_percentile":4911.94,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"20","median_amount":5822.0,"10th_percentile":4948.7,"90th_percentile":10439.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5780.0,"10th_percentile":5780.0,"90th_percentile":9576.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7559.03,"10th_percentile":5051.58,"90th_percentile":7563.04,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8663.36,"10th_percentile":8663.36,"90th_percentile":8663.36,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7563.29,"10th_percentile":7563.29,"90th_percentile":8103.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":42353.77,"10th_percentile":42353.77,"90th_percentile":42353.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":40091.65,"10th_percentile":36696.14,"90th_percentile":47681.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7558.83,"10th_percentile":7558.83,"90th_percentile":7558.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":10388.25,"10th_percentile":9357.0,"90th_percentile":10760.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7586.23,"10th_percentile":7586.23,"90th_percentile":7586.23,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":6223.31,"10th_percentile":6223.31,"90th_percentile":6223.31,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2001.0,"10th_percentile":1999.4,"90th_percentile":2002.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5368.79,"10th_percentile":5368.79,"90th_percentile":5368.79,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":11339.6,"10th_percentile":9224.92,"90th_percentile":30529.71,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"12","median_amount":1690.8,"10th_percentile":1690.8,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1999.9,"10th_percentile":1994.9,"90th_percentile":2000.9,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1893.12,"10th_percentile":1893.12,"90th_percentile":1893.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"33","median_amount":9611.33,"10th_percentile":5578.5,"90th_percentile":18238.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3337.21,"10th_percentile":3051.3,"90th_percentile":10525.21},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":1690.8,"10th_percentile":1690.8,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6558.67,"10th_percentile":6558.67,"90th_percentile":6558.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"16","median_amount":1847.9,"10th_percentile":1700.9,"90th_percentile":2002.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1690.8,"10th_percentile":1690.8,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4811.8,"10th_percentile":2827.0,"90th_percentile":7263.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1994.9,"10th_percentile":1607.8,"90th_percentile":2347.96,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":844.0,"10th_percentile":492.34,"90th_percentile":1750.09,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"68","median_amount":301.56,"10th_percentile":280.05,"90th_percentile":437.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"28","median_amount":1533.0,"10th_percentile":1533.0,"90th_percentile":3295.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"21","median_amount":3077.0,"10th_percentile":1402.0,"90th_percentile":3792.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":500.96,"10th_percentile":309.14,"90th_percentile":500.96,"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":"1 through 10","median_amount":301.56,"10th_percentile":280.05,"90th_percentile":307.71,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":290.63,"10th_percentile":290.63,"90th_percentile":707.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"84","median_amount":1907.0,"10th_percentile":1401.0,"90th_percentile":3810.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":795.59,"10th_percentile":795.59,"90th_percentile":795.59},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":296.87,"10th_percentile":296.87,"90th_percentile":296.87,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":276.94,"10th_percentile":276.94,"90th_percentile":276.94,"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 ($): FEE SCHEDULE]","count":"91","median_amount":282.06,"10th_percentile":154.56,"90th_percentile":307.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":336.16,"10th_percentile":298.29,"90th_percentile":587.4,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":296.87,"10th_percentile":296.87,"90th_percentile":296.87,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"82","median_amount":1244.0,"10th_percentile":875.0,"90th_percentile":1533.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":301.56,"10th_percentile":176.23,"90th_percentile":306.56,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":3419.68,"10th_percentile":2201.64,"90th_percentile":5045.38,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1448.49,"10th_percentile":959.35,"90th_percentile":2084.33,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":716.79,"10th_percentile":373.79,"90th_percentile":1362.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7095.25,"10th_percentile":5916.0,"90th_percentile":9995.78,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"16","median_amount":6018.0,"10th_percentile":2760.0,"90th_percentile":14345.4,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"50","median_amount":959.35,"10th_percentile":643.57,"90th_percentile":1533.89,"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":965.07,"10th_percentile":965.07,"90th_percentile":965.07,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":671.37,"10th_percentile":671.37,"90th_percentile":680.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"37","median_amount":6186.93,"10th_percentile":2877.4,"90th_percentile":17341.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1155.63,"10th_percentile":1145.2,"90th_percentile":1684.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":959.35,"10th_percentile":959.35,"90th_percentile":2096.36,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"24","median_amount":653.9,"10th_percentile":400.0,"90th_percentile":719.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":698.2,"10th_percentile":698.2,"90th_percentile":698.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":710.35,"10th_percentile":710.35,"90th_percentile":722.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":10337.69,"10th_percentile":10337.69,"90th_percentile":10337.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":731.66,"10th_percentile":731.66,"90th_percentile":731.66,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"15","median_amount":1497.0,"10th_percentile":973.0,"90th_percentile":3169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":710.35,"10th_percentile":573.5,"90th_percentile":2095.71,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1039.43,"10th_percentile":1039.43,"90th_percentile":1039.43,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":912.28,"10th_percentile":909.5,"90th_percentile":2814.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6353.0,"10th_percentile":2741.0,"90th_percentile":8203.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":8455.73,"10th_percentile":2809.0,"90th_percentile":22147.4,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"47","median_amount":1381.57,"10th_percentile":921.05,"90th_percentile":1542.7,"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":2727.52,"10th_percentile":2727.52,"90th_percentile":2727.52,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1294.64,"10th_percentile":1294.64,"90th_percentile":1392.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"18","median_amount":6773.0,"10th_percentile":2757.4,"90th_percentile":17045.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":841.76,"10th_percentile":841.76,"90th_percentile":841.76},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1045.75,"10th_percentile":1045.75,"90th_percentile":1045.75,"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":"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":1439.02,"10th_percentile":1439.02,"90th_percentile":1439.02,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"32","median_amount":1145.78,"10th_percentile":526.61,"90th_percentile":1372.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1095.85,"10th_percentile":885.82,"90th_percentile":1598.79,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":959.35,"10th_percentile":959.35,"90th_percentile":959.35,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":978.54,"10th_percentile":978.54,"90th_percentile":978.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3025.0,"10th_percentile":2746.0,"90th_percentile":3169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2327.2,"10th_percentile":2327.2,"90th_percentile":2327.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"13","median_amount":914.5,"10th_percentile":735.08,"90th_percentile":1371.75,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1089.85,"10th_percentile":1089.85,"90th_percentile":1089.85,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3373.39,"10th_percentile":3373.39,"90th_percentile":3373.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":122127.34,"10th_percentile":122127.34,"90th_percentile":122127.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3521.19,"10th_percentile":3521.19,"90th_percentile":3521.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6704.47,"10th_percentile":6704.47,"90th_percentile":6704.47,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":6084.02,"10th_percentile":6084.02,"90th_percentile":6084.02},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6704.47,"10th_percentile":6704.47,"90th_percentile":6712.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":24696.44,"10th_percentile":24696.44,"90th_percentile":24696.44,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21906.98,"10th_percentile":21906.98,"90th_percentile":21906.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":110132.03,"10th_percentile":91298.42,"90th_percentile":124284.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21911.98,"10th_percentile":21911.98,"90th_percentile":21934.28,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":20789.27,"10th_percentile":20789.27,"90th_percentile":20789.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":34317.16,"10th_percentile":34317.16,"90th_percentile":34317.16},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21909.98,"10th_percentile":21772.76,"90th_percentile":21914.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":25812.89,"10th_percentile":25812.89,"90th_percentile":25812.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21911.98,"10th_percentile":21911.98,"90th_percentile":21914.88,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2535.75,"10th_percentile":2535.75,"90th_percentile":2535.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":8326.99,"10th_percentile":8326.99,"90th_percentile":8326.99,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":26745.32,"10th_percentile":26745.32,"90th_percentile":26745.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":14334.34,"10th_percentile":14334.34,"90th_percentile":14334.34},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2203.9,"10th_percentile":2203.9,"90th_percentile":2203.9,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":8570.0,"10th_percentile":8052.8,"90th_percentile":8600.1,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"15","median_amount":4114.64,"10th_percentile":3770.6,"90th_percentile":4122.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":31199.71,"10th_percentile":26765.74,"90th_percentile":47202.73,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"11","median_amount":31713.21,"10th_percentile":27352.95,"90th_percentile":39814.02,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":34754.35,"10th_percentile":34754.35,"90th_percentile":34754.35},{"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":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":4109.64,"10th_percentile":3840.14,"90th_percentile":4117.14,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"40","median_amount":33996.72,"10th_percentile":26295.19,"90th_percentile":43415.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":8446.2,"10th_percentile":5970.3,"90th_percentile":12924.8},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4113.14,"10th_percentile":4113.14,"90th_percentile":4113.14,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3698.68,"10th_percentile":3698.68,"90th_percentile":3698.68,"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 ($): FEE SCHEDULE]","count":"25","median_amount":4109.64,"10th_percentile":3717.64,"90th_percentile":4117.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3857.97,"10th_percentile":3857.97,"90th_percentile":3857.97,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3841.78,"10th_percentile":3841.78,"90th_percentile":3841.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"14","median_amount":6734.0,"10th_percentile":6168.35,"90th_percentile":7933.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5348.8,"10th_percentile":5348.8,"90th_percentile":5348.8,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":4109.64,"10th_percentile":3722.54,"90th_percentile":4117.54,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3835.24,"10th_percentile":3835.24,"90th_percentile":3835.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":37435.09,"10th_percentile":37435.09,"90th_percentile":37435.09,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":42471.84,"10th_percentile":36725.28,"90th_percentile":46823.55,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"11","median_amount":38526.18,"10th_percentile":34401.81,"90th_percentile":47430.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5259.21,"10th_percentile":5259.21,"90th_percentile":5279.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6429.0,"10th_percentile":6429.0,"90th_percentile":6429.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2175.06,"10th_percentile":2175.06,"90th_percentile":2175.06,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5271.01,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4996.61,"10th_percentile":4996.61,"90th_percentile":4996.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":30251.58,"10th_percentile":30251.58,"90th_percentile":30251.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2165.73,"10th_percentile":2165.73,"90th_percentile":2165.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":15653.14,"10th_percentile":15653.14,"90th_percentile":15653.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":4804.68,"10th_percentile":4804.68,"90th_percentile":4804.68,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"2212","median_amount":481.8,"10th_percentile":146.86,"90th_percentile":1203.31,"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":"168","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":227.22,"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 ($): FEE SCHEDULE]","count":"1477","median_amount":90.23,"10th_percentile":86.08,"90th_percentile":217.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":103.44,"10th_percentile":103.44,"90th_percentile":103.44,"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] [APC ($): FEE SCHEDULE]","count":"1769","median_amount":854.0,"10th_percentile":628.0,"90th_percentile":2489.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"732","median_amount":38.82,"10th_percentile":20.0,"90th_percentile":114.74,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"19","median_amount":854.0,"10th_percentile":566.95,"90th_percentile":3187.0},{"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":"4626","median_amount":70.52,"10th_percentile":60.94,"90th_percentile":295.84,"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":"450","median_amount":91.79,"10th_percentile":87.68,"90th_percentile":217.17,"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 ($): FEE SCHEDULE]","count":"73","median_amount":85.36,"10th_percentile":85.36,"90th_percentile":200.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"13158","median_amount":854.0,"10th_percentile":628.0,"90th_percentile":2424.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1399","median_amount":298.9,"10th_percentile":201.6,"90th_percentile":857.31},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"139","median_amount":90.15,"10th_percentile":67.07,"90th_percentile":193.25,"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":"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":"186","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":227.22,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.43,"10th_percentile":86.43,"90th_percentile":86.43,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":81.36,"10th_percentile":80.96,"90th_percentile":207.26,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"2581","median_amount":91.79,"10th_percentile":70.52,"90th_percentile":202.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"161","median_amount":69.99,"10th_percentile":67.71,"90th_percentile":205.39,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"275","median_amount":70.52,"10th_percentile":67.71,"90th_percentile":252.13,"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 ($): FEE SCHEDULE]","count":"18","median_amount":71.96,"10th_percentile":67.71,"90th_percentile":90.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"92","median_amount":71.93,"10th_percentile":69.06,"90th_percentile":301.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":74.12,"10th_percentile":70.52,"90th_percentile":201.95,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":71.96,"10th_percentile":71.96,"90th_percentile":71.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"2581","median_amount":389.0,"10th_percentile":298.24,"90th_percentile":1018.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"382","median_amount":386.0,"10th_percentile":371.0,"90th_percentile":1009.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1140","median_amount":90.33,"10th_percentile":70.52,"90th_percentile":206.57,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":85.93,"10th_percentile":67.71,"90th_percentile":89.95,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":70.52,"10th_percentile":70.52,"90th_percentile":70.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":89.95,"10th_percentile":89.95,"90th_percentile":97.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1922","median_amount":1007.4,"10th_percentile":177.36,"90th_percentile":2039.4,"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":"147","median_amount":134.01,"10th_percentile":70.52,"90th_percentile":310.62,"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 ($): FEE SCHEDULE]","count":"1608","median_amount":108.83,"10th_percentile":108.63,"90th_percentile":224.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":207.46,"10th_percentile":86.91,"90th_percentile":904.32,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"1830","median_amount":1821.48,"10th_percentile":1136.0,"90th_percentile":3399.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"387","median_amount":45.0,"10th_percentile":20.0,"90th_percentile":250.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"13","median_amount":1540.0,"10th_percentile":1136.0,"90th_percentile":3399.0},{"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":"3721","median_amount":137.26,"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":"472","median_amount":108.63,"10th_percentile":105.96,"90th_percentile":217.27,"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 ($): FEE SCHEDULE]","count":"111","median_amount":103.09,"10th_percentile":103.09,"90th_percentile":206.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"10875","median_amount":1727.61,"10th_percentile":1136.0,"90th_percentile":3399.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1277","median_amount":602.0,"10th_percentile":385.67,"90th_percentile":1189.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"153","median_amount":108.63,"10th_percentile":84.13,"90th_percentile":217.26,"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":"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":"149","median_amount":131.78,"10th_percentile":70.52,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":104.76,"10th_percentile":104.76,"90th_percentile":105.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"35","median_amount":98.17,"10th_percentile":97.77,"90th_percentile":99.77,"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 ($): FEE SCHEDULE]","count":"3010","median_amount":110.85,"10th_percentile":104.36,"90th_percentile":224.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"152","median_amount":105.8,"10th_percentile":84.3,"90th_percentile":196.93,"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":"180","median_amount":134.01,"10th_percentile":70.52,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":109.08,"10th_percentile":86.91,"90th_percentile":137.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"82","median_amount":131.23,"10th_percentile":71.93,"90th_percentile":230.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":112.35,"10th_percentile":69.06,"90th_percentile":377.36,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.91,"10th_percentile":86.91,"90th_percentile":86.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"2157","median_amount":686.0,"10th_percentile":321.97,"90th_percentile":1385.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"351","median_amount":681.0,"10th_percentile":386.0,"90th_percentile":1786.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1234","median_amount":108.94,"10th_percentile":93.94,"90th_percentile":217.68,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":223.44,"10th_percentile":223.44,"90th_percentile":957.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.42,"10th_percentile":183.42,"90th_percentile":183.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"Level 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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"534","median_amount":1515.0,"10th_percentile":403.15,"90th_percentile":2571.6,"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":"48","median_amount":303.01,"10th_percentile":211.47,"90th_percentile":480.76,"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 ($): FEE SCHEDULE]","count":"426","median_amount":247.94,"10th_percentile":232.65,"90th_percentile":428.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":247.94,"10th_percentile":247.94,"90th_percentile":247.94,"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] [APC ($): FEE SCHEDULE]","count":"507","median_amount":4406.5,"10th_percentile":2708.19,"90th_percentile":7308.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"157","median_amount":209.52,"10th_percentile":30.0,"90th_percentile":4266.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":4590.0,"10th_percentile":4280.41,"90th_percentile":5278.0},{"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":"1101","median_amount":303.01,"10th_percentile":126.43,"90th_percentile":444.05,"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":"125","median_amount":247.93,"10th_percentile":231.7,"90th_percentile":382.08,"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":"[APC ($): FEE SCHEDULE]","count":"32","median_amount":234.33,"10th_percentile":234.33,"90th_percentile":359.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"3045","median_amount":4353.16,"10th_percentile":2662.16,"90th_percentile":7082.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"374","median_amount":1463.7,"10th_percentile":783.72,"90th_percentile":2330.88},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"56","median_amount":251.97,"10th_percentile":100.0,"90th_percentile":551.93,"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":"46","median_amount":303.01,"10th_percentile":137.26,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":234.7,"10th_percentile":234.7,"90th_percentile":234.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":222.23,"10th_percentile":203.73,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"924","median_amount":249.93,"10th_percentile":99.93,"90th_percentile":363.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"46","median_amount":240.5,"10th_percentile":239.52,"90th_percentile":352.15,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":303.01,"10th_percentile":203.27,"90th_percentile":401.12,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":290.91,"10th_percentile":247.94,"90th_percentile":441.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"20","median_amount":309.07,"10th_percentile":207.34,"90th_percentile":389.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":197.55,"10th_percentile":197.55,"90th_percentile":197.55,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"587","median_amount":1717.0,"10th_percentile":439.0,"90th_percentile":2366.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"98","median_amount":1968.95,"10th_percentile":544.8,"90th_percentile":2600.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"395","median_amount":247.94,"10th_percentile":99.94,"90th_percentile":441.54,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":231.7,"10th_percentile":231.7,"90th_percentile":231.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":249.93,"10th_percentile":249.93,"90th_percentile":249.93,"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."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"137","median_amount":2514.0,"10th_percentile":914.5,"90th_percentile":3504.29,"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":"12","median_amount":679.01,"10th_percentile":543.79,"90th_percentile":752.19,"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 ($): FEE SCHEDULE]","count":"121","median_amount":628.53,"10th_percentile":495.06,"90th_percentile":874.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"141","median_amount":3811.5,"10th_percentile":3068.72,"90th_percentile":6554.63,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":815.02,"10th_percentile":51.93,"90th_percentile":5699.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":3587.32,"10th_percentile":3587.32,"90th_percentile":3587.32},{"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":"270","median_amount":589.5,"10th_percentile":326.91,"90th_percentile":852.82,"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":"39","median_amount":627.33,"10th_percentile":529.33,"90th_percentile":874.3,"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 ($): FEE SCHEDULE]","count":"14","median_amount":597.41,"10th_percentile":597.41,"90th_percentile":831.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"772","median_amount":3873.64,"10th_percentile":3171.39,"90th_percentile":6364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"101","median_amount":1466.5,"10th_percentile":925.51,"90th_percentile":1850.67},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":629.49,"10th_percentile":550.33,"90th_percentile":904.56,"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":"12","median_amount":679.46,"10th_percentile":559.94,"90th_percentile":752.19,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":504.61,"10th_percentile":504.61,"90th_percentile":545.47,"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 ($): FEE SCHEDULE]","count":"280","median_amount":633.15,"10th_percentile":493.68,"90th_percentile":840.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":587.74,"10th_percentile":565.89,"90th_percentile":1119.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":589.5,"10th_percentile":522.08,"90th_percentile":752.19,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":598.59,"10th_percentile":598.59,"90th_percentile":598.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":600.38,"10th_percentile":471.67,"90th_percentile":600.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"142","median_amount":1220.0,"10th_percentile":664.8,"90th_percentile":2203.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"20","median_amount":825.0,"10th_percentile":825.0,"90th_percentile":2478.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"111","median_amount":626.37,"10th_percentile":478.99,"90th_percentile":758.1,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":609.65,"10th_percentile":609.65,"90th_percentile":609.65,"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."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"176","median_amount":1364.1,"10th_percentile":305.07,"90th_percentile":2417.68,"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":"[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":387.24,"10th_percentile":366.5,"90th_percentile":703.81,"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 ($): FEE SCHEDULE]","count":"276","median_amount":273.39,"10th_percentile":181.86,"90th_percentile":448.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"189","median_amount":6620.69,"10th_percentile":2003.0,"90th_percentile":14717.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"77","median_amount":45.0,"10th_percentile":20.0,"90th_percentile":302.56,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":4758.39,"10th_percentile":4758.39,"90th_percentile":4758.39},{"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":"310","median_amount":381.74,"10th_percentile":142.69,"90th_percentile":471.92,"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":"97","median_amount":185.57,"10th_percentile":173.73,"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 ($): FEE SCHEDULE]","count":"14","median_amount":421.83,"10th_percentile":172.58,"90th_percentile":421.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1039","median_amount":6584.0,"10th_percentile":2003.0,"90th_percentile":14717.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"107","median_amount":1520.4,"10th_percentile":542.76,"90th_percentile":4366.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":185.57,"10th_percentile":149.23,"90th_percentile":651.21,"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":"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":381.74,"10th_percentile":222.93,"90th_percentile":662.65,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"543","median_amount":185.57,"10th_percentile":125.28,"90th_percentile":447.51,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":211.29,"10th_percentile":169.21,"90th_percentile":380.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"19","median_amount":256.08,"10th_percentile":142.69,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":222.93,"10th_percentile":148.62,"90th_percentile":387.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":389.37,"10th_percentile":389.37,"90th_percentile":389.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":264.96,"10th_percentile":264.96,"90th_percentile":264.96,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"193","median_amount":1799.0,"10th_percentile":370.0,"90th_percentile":3604.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"37","median_amount":1880.8,"10th_percentile":386.0,"90th_percentile":3975.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"249","median_amount":248.51,"10th_percentile":157.73,"90th_percentile":447.51,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":277.35,"10th_percentile":277.35,"90th_percentile":277.35,"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."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"387","median_amount":1396.1,"10th_percentile":595.65,"90th_percentile":3148.8,"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":"46","median_amount":492.28,"10th_percentile":371.78,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"396","median_amount":366.32,"10th_percentile":362.91,"90th_percentile":616.23,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":502.5,"10th_percentile":502.5,"90th_percentile":502.5,"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":"[Lesser Than Charges paid at %: 100] [APC ($): FEE SCHEDULE]","count":"404","median_amount":10019.97,"10th_percentile":7396.57,"90th_percentile":13908.9,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"203","median_amount":75.0,"10th_percentile":30.0,"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":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":9514.35,"10th_percentile":8679.0,"90th_percentile":15174.0},{"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":"692","median_amount":490.83,"10th_percentile":342.96,"90th_percentile":751.06,"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":"[APC ($): FEE SCHEDULE]","count":"145","median_amount":368.33,"10th_percentile":266.83,"90th_percentile":583.98,"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":"[APC ($): FEE SCHEDULE]","count":"24","median_amount":346.22,"10th_percentile":346.22,"90th_percentile":346.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"2417","median_amount":10296.87,"10th_percentile":7460.56,"90th_percentile":14674.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"227","median_amount":2739.8,"10th_percentile":1443.81,"90th_percentile":5027.41},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":368.33,"10th_percentile":95.33,"90th_percentile":390.63,"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":"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":"31","median_amount":511.24,"10th_percentile":366.5,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.35,"10th_percentile":132.35,"90th_percentile":540.94,"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 ($): FEE SCHEDULE]","count":"842","median_amount":367.83,"10th_percentile":216.64,"90th_percentile":671.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"51","median_amount":355.33,"10th_percentile":355.33,"90th_percentile":677.66,"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":"43","median_amount":511.24,"10th_percentile":366.32,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":428.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"15","median_amount":450.59,"10th_percentile":373.83,"90th_percentile":521.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":719.57,"10th_percentile":719.57,"90th_percentile":719.57,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":366.32,"10th_percentile":366.32,"90th_percentile":366.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"461","median_amount":1805.83,"10th_percentile":460.0,"90th_percentile":3785.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"80","median_amount":1792.83,"10th_percentile":439.0,"90th_percentile":3282.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"322","median_amount":366.33,"10th_percentile":217.84,"90th_percentile":585.37,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.1,"10th_percentile":160.1,"90th_percentile":160.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":3144.0,"10th_percentile":2857.2,"90th_percentile":3461.72,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":810.39,"10th_percentile":810.39,"90th_percentile":810.39,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9221.0,"10th_percentile":9221.0,"90th_percentile":9221.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":9954.0,"10th_percentile":8199.0,"90th_percentile":13395.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1176.42,"10th_percentile":1129.46,"90th_percentile":1176.42,"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":"1 through 10","median_amount":1259.11,"10th_percentile":1259.11,"90th_percentile":1259.11,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"24","median_amount":9543.0,"10th_percentile":8456.0,"90th_percentile":9990.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":2640.05,"10th_percentile":2640.05,"90th_percentile":2652.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1174.93,"10th_percentile":1174.93,"90th_percentile":1174.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1651.0,"10th_percentile":1170.9,"90th_percentile":3169.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1639.0,"10th_percentile":1639.0,"90th_percentile":1639.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":645.69,"10th_percentile":645.69,"90th_percentile":645.69,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"25","median_amount":1864.8,"10th_percentile":897.28,"90th_percentile":3712.3,"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":461.46,"10th_percentile":461.46,"90th_percentile":631.56,"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 ($): FEE SCHEDULE]","count":"23","median_amount":412.18,"10th_percentile":410.5,"90th_percentile":523.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"14","median_amount":3483.67,"10th_percentile":3009.0,"90th_percentile":17689.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":222.56,"10th_percentile":222.56,"90th_percentile":222.56,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":461.46,"10th_percentile":441.29,"90th_percentile":657.83,"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":"15","median_amount":416.5,"10th_percentile":410.5,"90th_percentile":855.01,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":389.56,"10th_percentile":389.56,"90th_percentile":389.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"136","median_amount":3108.0,"10th_percentile":2737.59,"90th_percentile":17778.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":926.45,"10th_percentile":611.52,"90th_percentile":5367.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":214.5,"10th_percentile":214.5,"90th_percentile":415.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_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":461.46,"10th_percentile":461.46,"90th_percentile":461.46,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"67","median_amount":410.5,"10th_percentile":219.4,"90th_percentile":855.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":663.49,"10th_percentile":399.81,"90th_percentile":663.49,"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":"1 through 10","median_amount":461.46,"10th_percentile":461.46,"90th_percentile":461.46,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":412.18,"10th_percentile":412.18,"90th_percentile":412.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":470.69,"10th_percentile":470.69,"90th_percentile":470.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"31","median_amount":1620.0,"10th_percentile":1270.0,"90th_percentile":5218.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1448.1,"10th_percentile":1448.1,"90th_percentile":1609.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"20","median_amount":410.51,"10th_percentile":214.51,"90th_percentile":415.51,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":2128.8,"10th_percentile":897.76,"90th_percentile":6822.78,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":552.88,"10th_percentile":443.83,"90th_percentile":3607.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"14","median_amount":4088.22,"10th_percentile":3548.0,"90th_percentile":29813.43,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":5926.0,"10th_percentile":651.89,"90th_percentile":9399.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":900.77,"10th_percentile":461.46,"90th_percentile":2915.56,"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":555.88,"10th_percentile":555.88,"90th_percentile":1257.88,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3965.75,"10th_percentile":3965.75,"90th_percentile":3965.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"53","median_amount":3891.0,"10th_percentile":3306.93,"90th_percentile":22665.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"12","median_amount":1170.4,"10th_percentile":970.2,"90th_percentile":1697.68},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3360.55,"10th_percentile":3360.55,"90th_percentile":3360.55,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":494.89,"10th_percentile":494.89,"90th_percentile":494.89,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":643.73,"10th_percentile":358.78,"90th_percentile":4427.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1341.27,"10th_percentile":1341.27,"90th_percentile":1341.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":486.62,"10th_percentile":486.62,"90th_percentile":486.62,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"13","median_amount":1620.0,"10th_percentile":1174.78,"90th_percentile":8612.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1609.0,"10th_percentile":1609.0,"90th_percentile":1609.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1216.0,"10th_percentile":1216.0,"90th_percentile":1216.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"16","median_amount":5952.0,"10th_percentile":3513.34,"90th_percentile":7239.05,"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":1294.2,"10th_percentile":1294.2,"90th_percentile":1346.63,"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 ($): FEE SCHEDULE]","count":"47","median_amount":1371.87,"10th_percentile":1154.58,"90th_percentile":1998.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"23","median_amount":11343.0,"10th_percentile":10558.08,"90th_percentile":20787.78,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":1744.41,"10th_percentile":1744.41,"90th_percentile":28547.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1346.63,"10th_percentile":1294.2,"90th_percentile":1744.64,"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":1196.03,"10th_percentile":352.7,"90th_percentile":2939.33,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1338.38,"10th_percentile":1338.38,"90th_percentile":2984.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"94","median_amount":11404.05,"10th_percentile":10312.52,"90th_percentile":14758.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3303.84,"10th_percentile":2232.19,"90th_percentile":4168.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1380.7,"10th_percentile":1380.7,"90th_percentile":1380.7,"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":"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":241.37,"10th_percentile":241.37,"90th_percentile":241.37,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1234.16,"10th_percentile":1234.16,"90th_percentile":1234.16,"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":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"88","median_amount":1378.99,"10th_percentile":1122.53,"90th_percentile":2078.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1276.64,"10th_percentile":1276.64,"90th_percentile":1324.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1346.63,"10th_percentile":1346.63,"90th_percentile":2934.85,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"12","median_amount":2554.0,"10th_percentile":2043.2,"90th_percentile":3249.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2537.0,"10th_percentile":2537.0,"90th_percentile":2537.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"34","median_amount":1369.62,"10th_percentile":1219.62,"90th_percentile":3009.99,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"35","median_amount":5988.6,"10th_percentile":2432.74,"90th_percentile":28778.04,"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":"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"60","median_amount":1490.75,"10th_percentile":1482.28,"90th_percentile":6395.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"48","median_amount":9981.0,"10th_percentile":9731.79,"90th_percentile":29146.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"12","median_amount":30.0,"10th_percentile":30.0,"90th_percentile":1343.05,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":9981.0,"10th_percentile":9981.0,"90th_percentile":9981.0},{"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":1675.47,"10th_percentile":1608.59,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":1490.05,"10th_percentile":1479.28,"90th_percentile":4114.19,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1414.03,"10th_percentile":1414.03,"90th_percentile":1414.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"225","median_amount":9981.0,"10th_percentile":9437.0,"90th_percentile":35990.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"27","median_amount":3230.5,"10th_percentile":3047.8,"90th_percentile":11235.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":5577.24,"10th_percentile":1495.55,"90th_percentile":8377.29,"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":"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":1608.59,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"170","median_amount":1493.05,"10th_percentile":1343.05,"90th_percentile":5982.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":1451.25,"10th_percentile":1451.25,"90th_percentile":3060.08,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":1608.59,"90th_percentile":2310.12,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":86.32,"10th_percentile":86.32,"90th_percentile":86.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1825.37,"10th_percentile":1825.37,"90th_percentile":1825.37,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"34","median_amount":2502.0,"10th_percentile":2251.8,"90th_percentile":11594.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2485.0,"10th_percentile":2485.0,"90th_percentile":2502.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"69","median_amount":1493.06,"10th_percentile":1343.06,"90th_percentile":5249.33,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":23191.8,"10th_percentile":4457.88,"90th_percentile":30988.2,"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":7792.72,"10th_percentile":7792.72,"90th_percentile":7792.72,"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 ($): FEE SCHEDULE]","count":"13","median_amount":5096.62,"10th_percentile":879.59,"90th_percentile":7664.53,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"14","median_amount":18497.0,"10th_percentile":6124.14,"90th_percentile":66901.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":35.49,"10th_percentile":35.49,"90th_percentile":35.49,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":555.42,"10th_percentile":486.39,"90th_percentile":2374.55,"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":1253.56,"10th_percentile":1253.56,"90th_percentile":1253.56,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":834.72,"10th_percentile":834.72,"90th_percentile":834.72,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"22","median_amount":8085.0,"10th_percentile":4342.0,"90th_percentile":40559.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":21634.55,"10th_percentile":21634.55,"90th_percentile":21634.55},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":518.5,"10th_percentile":518.5,"90th_percentile":5379.74,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"37","median_amount":1987.77,"10th_percentile":641.25,"90th_percentile":6347.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4972.96,"10th_percentile":4972.96,"90th_percentile":4972.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":2600.49,"10th_percentile":521.65,"90th_percentile":3646.71,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":21683.18,"10th_percentile":1715.18,"90th_percentile":21683.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":2465.1,"10th_percentile":730.01,"90th_percentile":5982.03,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"14","median_amount":8322.88,"10th_percentile":4825.34,"90th_percentile":24532.8,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"14","median_amount":3425.02,"10th_percentile":2531.93,"90th_percentile":3953.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":30739.0,"10th_percentile":30739.0,"90th_percentile":38364.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":30.0,"10th_percentile":9.97,"90th_percentile":35.49,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"17","median_amount":2187.93,"10th_percentile":1614.33,"90th_percentile":5899.26,"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":"1 through 10","median_amount":3235.01,"10th_percentile":3058.22,"90th_percentile":3235.01,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8688.73,"10th_percentile":2902.2,"90th_percentile":8688.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"47","median_amount":40989.0,"10th_percentile":25969.0,"90th_percentile":49522.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":9190.3,"10th_percentile":9190.3,"90th_percentile":9734.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":2326.62,"10th_percentile":2326.62,"90th_percentile":2326.62,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"48","median_amount":3649.17,"10th_percentile":2040.09,"90th_percentile":4691.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":2831.2,"10th_percentile":2682.93,"90th_percentile":2831.2,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3022.82,"10th_percentile":3022.82,"90th_percentile":3022.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4398.0,"10th_percentile":4398.0,"90th_percentile":4398.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"17","median_amount":3168.13,"10th_percentile":2472.93,"90th_percentile":3955.28,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"12","median_amount":12641.4,"10th_percentile":4993.8,"90th_percentile":49437.6,"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":"1 through 10","median_amount":7173.72,"10th_percentile":7173.72,"90th_percentile":7173.72,"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 ($): FEE SCHEDULE]","count":"11","median_amount":4436.79,"10th_percentile":1614.56,"90th_percentile":6550.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"15","median_amount":77297.0,"10th_percentile":15768.0,"90th_percentile":118132.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":435.49,"10th_percentile":35.49,"90th_percentile":1000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":4298.26,"10th_percentile":786.52,"90th_percentile":7458.68,"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":1614.55,"10th_percentile":1614.55,"90th_percentile":4572.42,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4594.04,"10th_percentile":4594.04,"90th_percentile":4594.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"63","median_amount":62695.0,"10th_percentile":17808.0,"90th_percentile":114075.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":25655.35,"10th_percentile":23751.0,"90th_percentile":29685.25},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":6124.05,"10th_percentile":2487.59,"90th_percentile":6124.05,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"37","median_amount":3976.91,"10th_percentile":941.61,"90th_percentile":7140.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9248.07,"10th_percentile":9248.07,"90th_percentile":9248.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":3646.1,"10th_percentile":3646.1,"90th_percentile":3646.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":29184.0,"10th_percentile":16859.0,"90th_percentile":38400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":29718.0,"10th_percentile":29718.0,"90th_percentile":29718.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":4831.21,"10th_percentile":945.47,"90th_percentile":7273.67,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"17","median_amount":19217.34,"10th_percentile":8683.38,"90th_percentile":82180.8,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"34","median_amount":7605.81,"10th_percentile":1232.2,"90th_percentile":12361.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"13","median_amount":73180.0,"10th_percentile":56221.0,"90th_percentile":152848.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":35.49,"10th_percentile":34.68,"90th_percentile":35.49,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":5644.68,"10th_percentile":916.68,"90th_percentile":11263.79,"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":8935.67,"10th_percentile":506.52,"90th_percentile":11479.52,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11426.42,"10th_percentile":11426.42,"90th_percentile":11426.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"52","median_amount":69533.0,"10th_percentile":9151.0,"90th_percentile":150872.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":24635.8,"10th_percentile":4512.9,"90th_percentile":50624.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"53","median_amount":7498.29,"10th_percentile":2894.38,"90th_percentile":11808.9,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11464.04,"10th_percentile":11464.04,"90th_percentile":11464.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":4598.45,"10th_percentile":4523.33,"90th_percentile":12508.28,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":12288.0,"10th_percentile":947.18,"90th_percentile":25344.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":11609.18,"10th_percentile":11609.18,"90th_percentile":11609.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"28","median_amount":5769.92,"10th_percentile":505.63,"90th_percentile":11170.47,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":37839.0,"10th_percentile":28876.8,"90th_percentile":56428.8,"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":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":84072.0,"10th_percentile":72690.0,"90th_percentile":84672.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":6094.36,"10th_percentile":6094.36,"90th_percentile":6094.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":10670.69,"10th_percentile":10670.69,"90th_percentile":10670.69,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":105795.0,"10th_percentile":63764.0,"90th_percentile":120818.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9499.33,"10th_percentile":9499.33,"90th_percentile":9499.33,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"18","median_amount":12481.35,"10th_percentile":7447.62,"90th_percentile":13516.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":20669.88,"10th_percentile":20669.88,"90th_percentile":20669.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":30024.0,"10th_percentile":30024.0,"90th_percentile":30024.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8201.31,"10th_percentile":2566.8,"90th_percentile":11653.64,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Level 7 Radiation Therapy","code_information":[{"code":"5627","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7941.04,"10th_percentile":7941.04,"90th_percentile":7941.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":9225.82,"10th_percentile":9225.82,"90th_percentile":9225.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":104194.0,"10th_percentile":104194.0,"90th_percentile":104194.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":13033.11,"10th_percentile":13033.11,"90th_percentile":13033.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":7809.9,"10th_percentile":7809.9,"90th_percentile":7809.9,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":46094.4,"10th_percentile":1320.0,"90th_percentile":175680.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":341.34,"10th_percentile":341.34,"90th_percentile":43704.88,"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":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":47528.83,"10th_percentile":228.97,"90th_percentile":49852.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":47308.37,"10th_percentile":47308.37,"90th_percentile":47308.37,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"17","median_amount":292800.0,"10th_percentile":292800.0,"90th_percentile":341400.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49852.05,"10th_percentile":47308.37,"90th_percentile":49852.05,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"17","median_amount":50373.41,"10th_percentile":47316.26,"90th_percentile":61515.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":39089.77,"10th_percentile":39089.77,"90th_percentile":39089.77,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":113556.0,"10th_percentile":113483.0,"90th_percentile":113556.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49852.06,"10th_percentile":49852.06,"90th_percentile":50386.55,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"567","median_amount":1399.39,"10th_percentile":89.12,"90th_percentile":6568.66,"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":"43","median_amount":273.7,"10th_percentile":40.49,"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 ($): FEE SCHEDULE]","count":"375","median_amount":1204.52,"10th_percentile":54.59,"90th_percentile":1806.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"677","median_amount":2172.0,"10th_percentile":724.0,"90th_percentile":13419.01,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"594","median_amount":11339.11,"10th_percentile":6353.11,"90th_percentile":15857.59,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":1448.0,"10th_percentile":582.1,"90th_percentile":14065.24},{"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":"893","median_amount":1188.15,"10th_percentile":40.49,"90th_percentile":1670.69,"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":"167","median_amount":957.78,"10th_percentile":49.69,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"39","median_amount":1143.06,"10th_percentile":908.92,"90th_percentile":1839.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"4097","median_amount":2172.0,"10th_percentile":723.0,"90th_percentile":13050.11,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"522","median_amount":760.2,"10th_percentile":253.4,"90th_percentile":4218.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"58","median_amount":961.28,"10th_percentile":54.59,"90th_percentile":1691.87,"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":"[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":1211.13,"10th_percentile":40.49,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1084.07,"10th_percentile":49.13,"90th_percentile":1515.07,"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 ($): FEE SCHEDULE]","count":"978","median_amount":1204.52,"10th_percentile":54.59,"90th_percentile":1806.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":1168.39,"10th_percentile":52.95,"90th_percentile":1752.58,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":1188.15,"10th_percentile":40.49,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1211.13,"10th_percentile":1211.13,"90th_percentile":1550.33,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1235.35,"10th_percentile":41.3,"90th_percentile":1853.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2004.19,"10th_percentile":2004.19,"90th_percentile":2004.19,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"585","median_amount":183.54,"10th_percentile":34.62,"90th_percentile":6201.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"85","median_amount":3975.0,"10th_percentile":34.62,"90th_percentile":6201.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"325","median_amount":1204.52,"10th_percentile":54.59,"90th_percentile":1918.18,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":995.86,"10th_percentile":995.86,"90th_percentile":995.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1121.82,"10th_percentile":1121.82,"90th_percentile":1121.82,"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":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"33","median_amount":496.82,"10th_percentile":242.95,"90th_percentile":5854.8,"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":1188.15,"10th_percentile":205.7,"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 ($): FEE SCHEDULE]","count":"42","median_amount":175.06,"10th_percentile":170.16,"90th_percentile":1945.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"44","median_amount":3064.0,"10th_percentile":1489.0,"90th_percentile":14198.58,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"24","median_amount":14674.11,"10th_percentile":50.13,"90th_percentile":21185.87,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"76","median_amount":299.47,"10th_percentile":167.09,"90th_percentile":1245.3,"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":"18","median_amount":178.23,"10th_percentile":170.16,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1597.52,"10th_percentile":1597.52,"90th_percentile":1707.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"212","median_amount":4313.0,"10th_percentile":1489.0,"90th_percentile":18105.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"28","median_amount":762.28,"10th_percentile":521.15,"90th_percentile":4747.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1806.78,"10th_percentile":1806.78,"90th_percentile":2289.18,"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":"1 through 10","median_amount":2544.19,"10th_percentile":2544.19,"90th_percentile":2544.19,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2285.68,"10th_percentile":2285.68,"90th_percentile":2285.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"112","median_amount":183.96,"10th_percentile":175.06,"90th_percentile":1940.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":169.8,"10th_percentile":169.8,"90th_percentile":5495.4,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":222.21,"10th_percentile":197.49,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1186.04,"10th_percentile":762.12,"90th_percentile":1893.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"42","median_amount":621.0,"10th_percentile":89.29,"90th_percentile":6246.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3146.0,"10th_percentile":370.63,"90th_percentile":4274.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"43","median_amount":182.9,"10th_percentile":175.06,"90th_percentile":3613.56,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"29","median_amount":423.88,"10th_percentile":142.41,"90th_percentile":3106.27,"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":"1 through 10","median_amount":192.33,"10th_percentile":192.33,"90th_percentile":239.24,"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":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":1748.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"27","median_amount":4378.0,"10th_percentile":1931.0,"90th_percentile":26647.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":10639.0,"10th_percentile":45.0,"90th_percentile":36086.18,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"50","median_amount":230.59,"10th_percentile":165.21,"90th_percentile":1162.78,"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":367.48,"10th_percentile":367.48,"90th_percentile":370.65,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":348.73,"10th_percentile":348.73,"90th_percentile":348.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"138","median_amount":3292.16,"10th_percentile":1218.0,"90th_percentile":35784.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"17","median_amount":626.29,"10th_percentile":325.04,"90th_percentile":1546.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":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":"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":8571.97,"10th_percentile":8571.97,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"25","median_amount":367.48,"10th_percentile":367.48,"90th_percentile":1790.91,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1503.82,"10th_percentile":1503.82,"90th_percentile":1503.82,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages 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":4402.3,"90th_percentile":4402.3,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":282.34,"10th_percentile":282.34,"90th_percentile":282.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"34","median_amount":366.13,"10th_percentile":93.81,"90th_percentile":2308.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":194.41,"10th_percentile":139.09,"90th_percentile":415.81,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":465.66,"10th_percentile":367.49,"90th_percentile":1942.92,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6089.55,"10th_percentile":3767.82,"90th_percentile":7088.7,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":23302.3,"10th_percentile":23233.59,"90th_percentile":30999.22,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":48888.94,"10th_percentile":48888.94,"90th_percentile":66083.35,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":3803.61,"10th_percentile":3803.61,"90th_percentile":3803.61,"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":1801.22,"10th_percentile":1801.22,"90th_percentile":1801.22,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6710.99,"10th_percentile":6710.99,"90th_percentile":6710.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":14961.6,"10th_percentile":6279.0,"90th_percentile":43491.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":25038.3,"10th_percentile":25038.3,"90th_percentile":25038.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1790.91,"10th_percentile":1508.19,"90th_percentile":3619.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":6995.47,"10th_percentile":6995.47,"90th_percentile":6995.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1937.92,"10th_percentile":1937.92,"90th_percentile":1937.92,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":2743.66,"10th_percentile":2743.66,"90th_percentile":2743.66,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":446.32,"10th_percentile":446.32,"90th_percentile":446.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":21309.82,"10th_percentile":14304.0,"90th_percentile":36423.79,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":34786.0,"10th_percentile":13766.0,"90th_percentile":58082.86,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":1869.76,"10th_percentile":1280.52,"90th_percentile":2877.17,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"55","median_amount":19825.0,"10th_percentile":10939.77,"90th_percentile":34719.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":3495.1,"10th_percentile":3495.1,"90th_percentile":4295.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":7.81,"10th_percentile":7.81,"90th_percentile":7.81,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4525.86,"10th_percentile":4525.86,"90th_percentile":4525.86,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5926.46,"10th_percentile":5926.46,"90th_percentile":5926.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2955.56,"10th_percentile":2887.9,"90th_percentile":3144.07,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"142","median_amount":135.28,"10th_percentile":135.28,"90th_percentile":673.62,"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":"1 through 10","median_amount":304.85,"10th_percentile":304.85,"90th_percentile":456.81,"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 ($): FEE SCHEDULE]","count":"26","median_amount":56.99,"10th_percentile":56.55,"90th_percentile":201.01,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":199.21,"10th_percentile":199.21,"90th_percentile":199.21,"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] [APC ($): FEE SCHEDULE]","count":"109","median_amount":259.0,"10th_percentile":259.0,"90th_percentile":934.13,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"255","median_amount":259.0,"10th_percentile":259.0,"90th_percentile":259.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":259.0,"10th_percentile":259.0,"90th_percentile":259.0},{"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":"134","median_amount":26.69,"10th_percentile":26.69,"90th_percentile":310.62,"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":"12","median_amount":56.99,"10th_percentile":56.55,"90th_percentile":1104.49,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50.09,"10th_percentile":50.09,"90th_percentile":50.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"797","median_amount":259.0,"10th_percentile":259.0,"90th_percentile":542.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"92","median_amount":90.65,"10th_percentile":90.65,"90th_percentile":169.46},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":73.5,"10th_percentile":73.5,"90th_percentile":102.12,"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":"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":58.17,"10th_percentile":26.69,"90th_percentile":522.42,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"50","median_amount":56.55,"10th_percentile":54.32,"90th_percentile":513.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":200.47,"10th_percentile":185.85,"90th_percentile":4967.06,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":26.69,"10th_percentile":26.69,"90th_percentile":355.97,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27.22,"10th_percentile":27.22,"90th_percentile":202.59,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"161","median_amount":160.58,"10th_percentile":160.58,"90th_percentile":410.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"19","median_amount":160.58,"10th_percentile":160.58,"90th_percentile":259.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":56.99,"10th_percentile":56.99,"90th_percentile":728.3,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"94","median_amount":1443.8,"10th_percentile":721.2,"90th_percentile":2369.84,"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":"[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":305.93,"10th_percentile":249.44,"90th_percentile":1002.5,"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":"[APC ($): FEE SCHEDULE]","count":"94","median_amount":346.89,"10th_percentile":215.24,"90th_percentile":394.03,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"71","median_amount":4222.58,"10th_percentile":2649.0,"90th_percentile":7631.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"77","median_amount":55.0,"10th_percentile":20.0,"90th_percentile":400.86,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"158","median_amount":603.76,"10th_percentile":249.44,"90th_percentile":962.48,"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":"[APC ($): FEE SCHEDULE]","count":"61","median_amount":348.01,"10th_percentile":327.66,"90th_percentile":474.96,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"435","median_amount":3453.58,"10th_percentile":1820.0,"90th_percentile":5732.97,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"71","median_amount":1276.88,"10th_percentile":917.87,"90th_percentile":1891.82},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":512.1,"10th_percentile":512.1,"90th_percentile":512.1,"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":"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":880.98,"10th_percentile":858.84,"90th_percentile":1319.79,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"105","median_amount":348.69,"10th_percentile":314.84,"90th_percentile":617.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":361.13,"10th_percentile":361.13,"90th_percentile":361.13,"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":"[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":1112.39,"10th_percentile":728.17,"90th_percentile":1265.05,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"17","median_amount":538.3,"10th_percentile":265.01,"90th_percentile":1762.79,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"133","median_amount":460.0,"10th_percentile":207.71,"90th_percentile":1366.88,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":574.0,"10th_percentile":216.99,"90th_percentile":1684.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"73","median_amount":279.8,"10th_percentile":219.23,"90th_percentile":395.24,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1117.77,"10th_percentile":1117.77,"90th_percentile":1117.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":5391.85,"10th_percentile":217.24,"90th_percentile":14247.25,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1649.98,"10th_percentile":809.82,"90th_percentile":11730.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":50992.0,"10th_percentile":50992.0,"90th_percentile":50992.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":41.1,"10th_percentile":11.25,"90th_percentile":49.79,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":61046.0,"10th_percentile":61046.0,"90th_percentile":61046.0},{"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":7705.87,"10th_percentile":427.77,"90th_percentile":13304.64,"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":4729.45,"10th_percentile":3857.18,"90th_percentile":11730.57,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":389.14,"10th_percentile":321.56,"90th_percentile":21192.19,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"38","median_amount":50781.0,"10th_percentile":8836.0,"90th_percentile":138270.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":5129.95,"10th_percentile":5129.95,"90th_percentile":5129.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":473.52,"10th_percentile":473.52,"90th_percentile":473.52,"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":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"21","median_amount":10191.54,"10th_percentile":899.16,"90th_percentile":20465.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":855.67,"10th_percentile":855.67,"90th_percentile":855.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":3735.38,"10th_percentile":3735.38,"90th_percentile":3735.38,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":5079.7,"10th_percentile":2911.05,"90th_percentile":17058.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1825.8,"10th_percentile":367.38,"90th_percentile":15313.49,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":14010.83,"10th_percentile":14010.83,"90th_percentile":14010.83,"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."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"97","median_amount":1001.4,"10th_percentile":260.96,"90th_percentile":1001.4,"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":190.64,"10th_percentile":190.64,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"45","median_amount":160.49,"10th_percentile":147.7,"90th_percentile":161.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"68","median_amount":1669.0,"10th_percentile":1432.69,"90th_percentile":1669.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":203.88,"10th_percentile":203.88,"90th_percentile":203.88,"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":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"81","median_amount":190.64,"10th_percentile":183.03,"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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"12","median_amount":161.84,"10th_percentile":159.84,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":151.68,"10th_percentile":151.68,"90th_percentile":151.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"420","median_amount":1669.0,"10th_percentile":1517.79,"90th_percentile":1669.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"59","median_amount":584.15,"10th_percentile":325.74,"90th_percentile":584.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":159.84,"10th_percentile":159.84,"90th_percentile":159.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":190.64,"10th_percentile":183.03,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"71","median_amount":159.84,"10th_percentile":159.84,"90th_percentile":161.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":155.68,"10th_percentile":155.05,"90th_percentile":155.68,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":183.03,"10th_percentile":139.63,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":160.49,"10th_percentile":160.49,"90th_percentile":160.49,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":194.45,"10th_percentile":194.45,"90th_percentile":194.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"87","median_amount":1155.0,"10th_percentile":431.26,"90th_percentile":1155.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"15","median_amount":1147.0,"10th_percentile":989.37,"90th_percentile":1147.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":160.5,"10th_percentile":127.88,"90th_percentile":163.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"61","median_amount":1399.8,"10th_percentile":519.38,"90th_percentile":1813.8,"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":266.72,"10th_percentile":200.11,"90th_percentile":416.1,"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":"[APC ($): FEE SCHEDULE]","count":"66","median_amount":318.12,"10th_percentile":306.22,"90th_percentile":354.35,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"52","median_amount":2693.0,"10th_percentile":1726.45,"90th_percentile":3353.26,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":30.74,"10th_percentile":30.74,"90th_percentile":405.76,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":1741.01,"10th_percentile":1741.01,"90th_percentile":1741.01},{"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":"138","median_amount":266.72,"10th_percentile":208.14,"90th_percentile":416.1,"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":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":318.12,"10th_percentile":318.12,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":301.89,"10th_percentile":301.89,"90th_percentile":301.89,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"346","median_amount":2763.73,"10th_percentile":1726.08,"90th_percentile":3023.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"41","median_amount":769.65,"10th_percentile":523.19,"90th_percentile":1303.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.32,"10th_percentile":308.32,"90th_percentile":435.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"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":256.07,"10th_percentile":228.58,"90th_percentile":279.13,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"156","median_amount":318.12,"10th_percentile":297.69,"90th_percentile":384.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":308.57,"10th_percentile":261.68,"90th_percentile":541.63,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":256.07,"10th_percentile":238.08,"90th_percentile":416.1,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":266.72,"10th_percentile":266.72,"90th_percentile":399.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":233.15,"10th_percentile":233.15,"90th_percentile":233.15,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":362.24,"10th_percentile":362.24,"90th_percentile":362.24,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"63","median_amount":1465.31,"10th_percentile":934.0,"90th_percentile":1874.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1783.94,"10th_percentile":1215.2,"90th_percentile":1874.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"53","median_amount":318.12,"10th_percentile":266.72,"90th_percentile":409.38,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":332.83,"10th_percentile":332.83,"90th_percentile":332.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":318.12,"10th_percentile":318.12,"90th_percentile":318.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":1145.94,"10th_percentile":884.98,"90th_percentile":1762.46,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":740.09,"10th_percentile":740.09,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1084.1,"10th_percentile":1084.1,"90th_percentile":1084.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":4413.0,"10th_percentile":2895.0,"90th_percentile":5202.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":2886.0,"10th_percentile":2886.0,"90th_percentile":2886.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"24","median_amount":562.82,"10th_percentile":562.82,"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":"1 through 10","median_amount":506.81,"10th_percentile":506.81,"90th_percentile":654.51,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"42","median_amount":4066.0,"10th_percentile":2864.0,"90th_percentile":4958.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1735.3,"10th_percentile":996.1,"90th_percentile":1820.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":540.35,"10th_percentile":540.35,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":682.29,"10th_percentile":542.45,"90th_percentile":1247.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":786.29,"10th_percentile":786.29,"90th_percentile":786.29,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":1859.17,"10th_percentile":1651.0,"90th_percentile":3073.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3073.96,"10th_percentile":3073.96,"90th_percentile":3073.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":661.04,"10th_percentile":661.04,"90th_percentile":661.04,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"76","median_amount":4452.0,"10th_percentile":2315.74,"90th_percentile":5308.2,"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":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 ($): FEE SCHEDULE]","count":"37","median_amount":1040.34,"10th_percentile":991.34,"90th_percentile":1043.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":975.65,"10th_percentile":975.65,"90th_percentile":975.65,"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] [APC ($): FEE SCHEDULE]","count":"48","median_amount":7420.0,"10th_percentile":6951.21,"90th_percentile":8847.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":1325.69,"10th_percentile":1325.69,"90th_percentile":1325.69,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":5965.68,"10th_percentile":5965.68,"90th_percentile":5965.68},{"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":"80","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":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1039.34,"10th_percentile":1028.84,"90th_percentile":1141.34,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":986.31,"10th_percentile":986.31,"90th_percentile":986.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"341","median_amount":7420.0,"10th_percentile":6836.0,"90th_percentile":8847.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"39","median_amount":2597.0,"10th_percentile":2077.6,"90th_percentile":3096.45},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1039.34,"10th_percentile":989.61,"90th_percentile":1039.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"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":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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"95","median_amount":1039.34,"10th_percentile":989.01,"90th_percentile":1039.74,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":976.16,"10th_percentile":976.16,"90th_percentile":976.16,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":953.0,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":1012.47,"10th_percentile":972.06,"90th_percentile":1012.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"64","median_amount":2907.88,"10th_percentile":1916.82,"90th_percentile":3025.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3004.0,"10th_percentile":2132.95,"90th_percentile":3025.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"37","median_amount":992.62,"10th_percentile":831.48,"90th_percentile":1040.34,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":990.34,"10th_percentile":990.34,"90th_percentile":990.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"26","median_amount":29.72,"10th_percentile":25.02,"90th_percentile":49.74,"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":"[Outpatient Services: Payer leverages 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":40.49,"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":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":25.02,"10th_percentile":20.12,"90th_percentile":37.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"33","median_amount":259.0,"10th_percentile":199.0,"90th_percentile":37985.96,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":84699.7,"10th_percentile":17.17,"90th_percentile":161412.73,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":425.0,"10th_percentile":425.0,"90th_percentile":425.0},{"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":33.46,"10th_percentile":28.91,"90th_percentile":49.17,"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":"13","median_amount":25.02,"10th_percentile":20.12,"90th_percentile":25.02,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"164","median_amount":238.96,"10th_percentile":199.0,"90th_percentile":1000.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"23","median_amount":69.65,"10th_percentile":69.65,"90th_percentile":273.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":25.02,"10th_percentile":25.02,"90th_percentile":25.02,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"33","median_amount":25.02,"10th_percentile":25.02,"90th_percentile":37.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":27.31,"10th_percentile":27.31,"90th_percentile":27.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":38.87,"10th_percentile":38.87,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"30","median_amount":11.99,"10th_percentile":8.09,"90th_percentile":149.47,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":16.65,"10th_percentile":16.65,"90th_percentile":16.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"27","median_amount":25.02,"10th_percentile":25.02,"90th_percentile":28.16,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"65","median_amount":100.98,"10th_percentile":65.46,"90th_percentile":432.6,"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":"11","median_amount":33.46,"10th_percentile":32.12,"90th_percentile":100.69,"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":"[APC ($): FEE SCHEDULE]","count":"99","median_amount":40.09,"10th_percentile":35.19,"90th_percentile":203.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"43","median_amount":245.0,"10th_percentile":236.33,"90th_percentile":782.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"24","median_amount":782.0,"10th_percentile":20.0,"90th_percentile":817.55,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"79","median_amount":33.46,"10th_percentile":32.12,"90th_percentile":47.26,"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":"31","median_amount":40.09,"10th_percentile":35.19,"90th_percentile":320.72,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.05,"10th_percentile":38.05,"90th_percentile":55.16,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"397","median_amount":290.12,"10th_percentile":236.63,"90th_percentile":782.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"44","median_amount":169.75,"10th_percentile":85.75,"90th_percentile":273.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.09,"10th_percentile":37.92,"90th_percentile":40.09,"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":"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":38.87,"10th_percentile":32.12,"90th_percentile":257.58,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":36.08,"10th_percentile":36.08,"90th_percentile":36.08,"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":"[APC ($): FEE SCHEDULE]","count":"158","median_amount":40.09,"10th_percentile":40.09,"90th_percentile":120.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.89,"10th_percentile":38.89,"90th_percentile":62.46,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":33.46,"10th_percentile":22.44,"90th_percentile":54.93,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":33.46,"10th_percentile":33.46,"90th_percentile":33.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":35.76,"10th_percentile":35.76,"90th_percentile":35.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":49.44,"10th_percentile":49.44,"90th_percentile":49.44,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"70","median_amount":30.57,"10th_percentile":11.33,"90th_percentile":77.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"17","median_amount":63.86,"10th_percentile":16.18,"90th_percentile":447.02,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"91","median_amount":40.1,"10th_percentile":40.1,"90th_percentile":101.6,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":37.92,"10th_percentile":37.92,"90th_percentile":37.92,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":11.02,"10th_percentile":11.02,"90th_percentile":11.02,"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 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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"449","median_amount":399.0,"10th_percentile":120.49,"90th_percentile":629.56,"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":"25","median_amount":93.39,"10th_percentile":40.09,"90th_percentile":127.93,"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 ($): FEE SCHEDULE]","count":"291","median_amount":70.02,"10th_percentile":54.88,"90th_percentile":186.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":56.36,"10th_percentile":56.36,"90th_percentile":56.36,"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] [APC ($): FEE SCHEDULE]","count":"402","median_amount":960.07,"10th_percentile":569.11,"90th_percentile":2208.07,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"81","median_amount":35.0,"10th_percentile":13.72,"90th_percentile":143.44,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":1352.31,"10th_percentile":579.07,"90th_percentile":1776.08},{"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":"656","median_amount":59.96,"10th_percentile":38.81,"90th_percentile":134.38,"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":"97","median_amount":68.75,"10th_percentile":60.68,"90th_percentile":83.21,"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":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":65.5,"10th_percentile":54.89,"90th_percentile":124.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"2801","median_amount":787.12,"10th_percentile":567.52,"90th_percentile":2166.31,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"285","median_amount":339.39,"10th_percentile":208.46,"90th_percentile":720.3},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"29","median_amount":69.99,"10th_percentile":65.75,"90th_percentile":111.43,"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":"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":"31","median_amount":56.38,"10th_percentile":32.28,"90th_percentile":147.95,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.14,"10th_percentile":8.14,"90th_percentile":8.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":62.53,"10th_percentile":62.53,"90th_percentile":91.87,"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 ($): FEE SCHEDULE]","count":"671","median_amount":70.86,"10th_percentile":50.86,"90th_percentile":102.5,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"25","median_amount":66.54,"10th_percentile":55.09,"90th_percentile":150.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"35","median_amount":52.05,"10th_percentile":38.81,"90th_percentile":133.84,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":41.77,"10th_percentile":41.77,"90th_percentile":41.77,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"18","median_amount":81.37,"10th_percentile":33.56,"90th_percentile":201.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":118.38,"10th_percentile":118.38,"90th_percentile":118.38,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"576","median_amount":406.72,"10th_percentile":171.74,"90th_percentile":537.32,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"92","median_amount":416.59,"10th_percentile":345.74,"90th_percentile":536.54,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"244","median_amount":69.0,"10th_percentile":35.67,"90th_percentile":87.8,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":8.14,"10th_percentile":8.14,"90th_percentile":8.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"347","median_amount":189.0,"10th_percentile":30.71,"90th_percentile":838.57,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":77.44,"10th_percentile":28.49,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"263","median_amount":131.68,"10th_percentile":126.78,"90th_percentile":157.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"226","median_amount":1761.96,"10th_percentile":694.0,"90th_percentile":3105.91,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"68","median_amount":35.49,"10th_percentile":15.0,"90th_percentile":196.57,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":2345.0,"10th_percentile":2345.0,"90th_percentile":2661.0},{"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":"533","median_amount":70.5,"10th_percentile":14.45,"90th_percentile":367.88,"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":"69","median_amount":131.68,"10th_percentile":126.78,"90th_percentile":158.7,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.96,"10th_percentile":124.96,"90th_percentile":124.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1321","median_amount":1766.16,"10th_percentile":694.0,"90th_percentile":3109.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"295","median_amount":572.6,"10th_percentile":225.75,"90th_percentile":1063.65},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":131.68,"10th_percentile":131.68,"90th_percentile":257.73,"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":"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":"36","median_amount":71.89,"10th_percentile":15.05,"90th_percentile":240.94,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"354","median_amount":131.68,"10th_percentile":131.65,"90th_percentile":159.45,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":128.22,"10th_percentile":117.16,"90th_percentile":204.79,"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":"[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":74.07,"10th_percentile":15.05,"90th_percentile":124.08,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.78,"10th_percentile":120.78,"90th_percentile":120.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"21","median_amount":74.97,"10th_percentile":22.91,"90th_percentile":157.75,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"399","median_amount":162.08,"10th_percentile":19.3,"90th_percentile":485.6,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"57","median_amount":168.41,"10th_percentile":23.28,"90th_percentile":673.08,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"180","median_amount":131.69,"10th_percentile":124.99,"90th_percentile":156.41,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":10.0,"10th_percentile":10.0,"90th_percentile":10.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":2659.2,"10th_percentile":2659.2,"90th_percentile":2659.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":38.09,"10th_percentile":38.09,"90th_percentile":38.09,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":245.1,"10th_percentile":245.1,"90th_percentile":245.1,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"62","median_amount":2156.4,"10th_percentile":630.0,"90th_percentile":4312.8,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"127","median_amount":909.15,"10th_percentile":374.82,"90th_percentile":1551.84,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"86","median_amount":4193.0,"10th_percentile":1198.0,"90th_percentile":7188.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":984.36,"10th_percentile":656.24,"90th_percentile":1804.66,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"68","median_amount":892.98,"10th_percentile":257.24,"90th_percentile":1543.44,"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":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1098.54,"10th_percentile":122.06,"90th_percentile":1586.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"308","median_amount":4193.0,"10th_percentile":1198.0,"90th_percentile":7188.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"50","median_amount":1132.14,"10th_percentile":209.65,"90th_percentile":2306.15},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1286.2,"10th_percentile":385.86,"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":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"280","median_amount":900.34,"10th_percentile":257.24,"90th_percentile":1543.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":643.1,"10th_percentile":499.05,"90th_percentile":1503.24,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"50","median_amount":2667.24,"10th_percentile":1069.14,"90th_percentile":4456.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":4085.18,"10th_percentile":2599.66,"90th_percentile":4827.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"81","median_amount":900.41,"10th_percentile":131.69,"90th_percentile":1543.56,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":2404.16,"10th_percentile":1993.2,"90th_percentile":5868.6,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"20","median_amount":676.41,"10th_percentile":576.19,"90th_percentile":1243.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":9092.07,"10th_percentile":5279.07,"90th_percentile":9760.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":762.73,"10th_percentile":762.73,"90th_percentile":785.98,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":678.57,"10th_percentile":578.57,"90th_percentile":2790.26,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"41","median_amount":4482.14,"10th_percentile":3893.0,"90th_percentile":9770.56,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":1847.46,"10th_percentile":1847.46,"90th_percentile":3018.66},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"25","median_amount":678.68,"10th_percentile":658.68,"90th_percentile":1237.71,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2497.0,"10th_percentile":1497.0,"90th_percentile":4225.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":3726.68,"10th_percentile":3726.68,"90th_percentile":3726.68,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":676.41,"10th_percentile":423.5,"90th_percentile":1237.61,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":931.8,"10th_percentile":808.09,"90th_percentile":9574.78,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":208.53,"10th_percentile":102.25,"90th_percentile":1683.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1910.82,"10th_percentile":1415.82,"90th_percentile":135133.23,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":80.0,"10th_percentile":60.0,"90th_percentile":91545.51,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":361.37,"10th_percentile":259.81,"90th_percentile":830.2,"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":1811.95,"10th_percentile":1811.95,"90th_percentile":1811.95,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":2169.05,"10th_percentile":2169.05,"90th_percentile":2169.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"56","median_amount":1678.82,"10th_percentile":1003.24,"90th_percentile":41431.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":469.62,"10th_percentile":378.28,"90th_percentile":583.32},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"16","median_amount":960.78,"10th_percentile":200.75,"90th_percentile":1683.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":4585.34,"10th_percentile":4585.34,"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":"Meridian","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":243.62,"10th_percentile":243.62,"90th_percentile":243.62,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"15","median_amount":460.0,"10th_percentile":410.0,"90th_percentile":4164.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":351.2,"10th_percentile":351.2,"90th_percentile":351.2,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":965.29,"10th_percentile":965.29,"90th_percentile":965.29,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":2405.34,"10th_percentile":2405.34,"90th_percentile":2405.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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":573.91,"10th_percentile":573.91,"90th_percentile":573.91,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":2064.0,"10th_percentile":2064.0,"90th_percentile":2064.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":335.99,"10th_percentile":335.99,"90th_percentile":335.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":2153.28,"10th_percentile":1333.13,"90th_percentile":4691.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":843.85,"10th_percentile":843.85,"90th_percentile":1362.2},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":290.62,"10th_percentile":290.62,"90th_percentile":290.62,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":500.08,"10th_percentile":500.08,"90th_percentile":500.08,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Glucagon hydrochloride","code_information":[{"code":"9042","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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":17506.57,"10th_percentile":17506.57,"90th_percentile":17506.57,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1234.05,"10th_percentile":1234.05,"90th_percentile":1234.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"234","median_amount":230.21,"10th_percentile":176.73,"90th_percentile":365.49,"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":"1 through 10","median_amount":38.44,"10th_percentile":38.44,"90th_percentile":38.44,"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":"[APC ($): FEE SCHEDULE]","count":"101","median_amount":146.68,"10th_percentile":140.81,"90th_percentile":203.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"142","median_amount":1003.0,"10th_percentile":523.0,"90th_percentile":1262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"475","median_amount":1003.0,"10th_percentile":782.0,"90th_percentile":1262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":1003.0,"10th_percentile":1003.0,"90th_percentile":1003.0},{"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":40.04,"10th_percentile":25.63,"90th_percentile":40.04,"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":"30","median_amount":146.68,"10th_percentile":140.81,"90th_percentile":203.67,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":40.25,"10th_percentile":40.25,"90th_percentile":40.25,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1018","median_amount":1003.0,"10th_percentile":658.0,"90th_percentile":1262.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"130","median_amount":350.0,"10th_percentile":200.55,"90th_percentile":441.7},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":152.78,"10th_percentile":146.68,"90th_percentile":203.67,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":183.3,"10th_percentile":183.3,"90th_percentile":183.3,"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 ($): FEE SCHEDULE]","count":"123","median_amount":146.68,"10th_percentile":142.01,"90th_percentile":203.67,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":193.5,"10th_percentile":193.5,"90th_percentile":193.5,"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":"1 through 10","median_amount":40.04,"10th_percentile":40.04,"90th_percentile":40.04,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"246","median_amount":621.86,"10th_percentile":324.26,"90th_percentile":782.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"35","median_amount":621.86,"10th_percentile":407.96,"90th_percentile":782.44,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"69","median_amount":146.7,"10th_percentile":142.02,"90th_percentile":203.69,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1441.27,"10th_percentile":1441.27,"90th_percentile":1441.27,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":125639.07,"10th_percentile":125639.07,"90th_percentile":125639.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":6677.4,"10th_percentile":6677.4,"90th_percentile":6677.4,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"0","additional_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] [APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HMO","methodology":"other","standard_charge_algorithm":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":27784.24,"10th_percentile":27784.24,"90th_percentile":27784.24,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"1 through 10","median_amount":8159.87,"10th_percentile":8159.87,"90th_percentile":8159.87,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"450","median_amount":295.2,"10th_percentile":173.4,"90th_percentile":481.8,"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":"32","median_amount":225.96,"10th_percentile":170.35,"90th_percentile":301.51,"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 ($): FEE SCHEDULE]","count":"476","median_amount":132.19,"10th_percentile":124.99,"90th_percentile":214.14,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.19,"10th_percentile":132.19,"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] [APC ($): FEE SCHEDULE]","count":"466","median_amount":451.0,"10th_percentile":279.0,"90th_percentile":710.79,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"489","median_amount":40.0,"10th_percentile":15.0,"90th_percentile":75.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":525.26,"10th_percentile":525.26,"90th_percentile":606.0},{"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":"1212","median_amount":231.35,"10th_percentile":169.72,"90th_percentile":320.76,"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":"[APC ($): FEE SCHEDULE]","count":"130","median_amount":131.65,"10th_percentile":124.99,"90th_percentile":242.19,"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 ($): FEE SCHEDULE]","count":"31","median_amount":124.94,"10th_percentile":124.94,"90th_percentile":124.94,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"3110","median_amount":467.76,"10th_percentile":275.36,"90th_percentile":631.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"358","median_amount":176.12,"10th_percentile":87.9,"90th_percentile":303.1},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":127.4,"10th_percentile":86.19,"90th_percentile":216.23,"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":"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":220.86,"10th_percentile":143.29,"90th_percentile":308.87,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","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 ($): FEE SCHEDULE]","count":"721","median_amount":131.65,"10th_percentile":131.65,"90th_percentile":214.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"23","median_amount":127.7,"10th_percentile":127.7,"90th_percentile":186.26,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"50","median_amount":243.52,"10th_percentile":156.6,"90th_percentile":370.59,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":132.19,"10th_percentile":132.19,"90th_percentile":134.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"24","median_amount":202.55,"10th_percentile":146.16,"90th_percentile":239.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":136.16,"10th_percentile":136.16,"90th_percentile":138.37,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"568","median_amount":410.0,"10th_percentile":119.79,"90th_percentile":460.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"73","median_amount":389.98,"10th_percentile":179.18,"90th_percentile":457.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"323","median_amount":131.66,"10th_percentile":124.99,"90th_percentile":228.92,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":97.35,"10th_percentile":72.85,"90th_percentile":191.65,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"10214","median_amount":82.83,"10th_percentile":13.1,"90th_percentile":228.23,"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":"631","median_amount":33.99,"10th_percentile":9.26,"90th_percentile":110.01,"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 ($): FEE SCHEDULE]","count":"6731","median_amount":43.12,"10th_percentile":12.3,"90th_percentile":120.3,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":41.11,"10th_percentile":10.74,"90th_percentile":83.1,"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] [APC ($): FEE SCHEDULE]","count":"7646","median_amount":722.42,"10th_percentile":204.0,"90th_percentile":1719.27,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1528","median_amount":33.03,"10th_percentile":12.95,"90th_percentile":163.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"81","median_amount":706.0,"10th_percentile":141.0,"90th_percentile":1509.0},{"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":"19632","median_amount":30.85,"10th_percentile":9.2,"90th_percentile":107.95,"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":"2349","median_amount":39.52,"10th_percentile":11.62,"90th_percentile":116.82,"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":"[APC ($): FEE SCHEDULE]","count":"324","median_amount":35.82,"10th_percentile":10.73,"90th_percentile":110.17,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"48844","median_amount":750.0,"10th_percentile":201.0,"90th_percentile":1707.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"6922","median_amount":243.6,"10th_percentile":46.9,"90th_percentile":567.49},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"611","median_amount":39.99,"10th_percentile":13.11,"90th_percentile":127.54,"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":"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":"749","median_amount":24.54,"10th_percentile":9.2,"90th_percentile":88.29,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"18","median_amount":36.78,"10th_percentile":11.24,"90th_percentile":118.07,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"135","median_amount":38.1,"10th_percentile":15.48,"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 ($): FEE SCHEDULE]","count":"14038","median_amount":43.61,"10th_percentile":13.11,"90th_percentile":119.36,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"613","median_amount":48.27,"10th_percentile":12.72,"90th_percentile":111.8,"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":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"736","median_amount":31.16,"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 ($): FEE SCHEDULE]","count":"69","median_amount":38.14,"10th_percentile":10.74,"90th_percentile":90.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"371","median_amount":31.23,"10th_percentile":9.38,"90th_percentile":106.52,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"36","median_amount":44.08,"10th_percentile":11.34,"90th_percentile":124.1,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":26.93,"10th_percentile":21.91,"90th_percentile":64.21,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"11732","median_amount":53.46,"10th_percentile":10.34,"90th_percentile":171.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1772","median_amount":59.28,"10th_percentile":13.31,"90th_percentile":176.69,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"5781","median_amount":43.69,"10th_percentile":12.17,"90th_percentile":117.71,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"22","median_amount":56.84,"10th_percentile":18.35,"90th_percentile":103.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":52.21,"10th_percentile":13.8,"90th_percentile":236.73,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"16","median_amount":25.24,"10th_percentile":7.91,"90th_percentile":198.41,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."}]}]},{"description":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"811","median_amount":702.0,"10th_percentile":193.08,"90th_percentile":2001.69,"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":"150","median_amount":226.35,"10th_percentile":55.0,"90th_percentile":572.1,"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":"[APC ($): FEE SCHEDULE]","count":"890","median_amount":214.31,"10th_percentile":72.81,"90th_percentile":466.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":307.37,"10th_percentile":307.37,"90th_percentile":307.37,"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] [APC ($): FEE SCHEDULE]","count":"786","median_amount":1862.0,"10th_percentile":647.54,"90th_percentile":4717.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"816","median_amount":80.0,"10th_percentile":29.74,"90th_percentile":225.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":2094.0,"10th_percentile":698.0,"90th_percentile":3205.0},{"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":"3088","median_amount":283.26,"10th_percentile":67.91,"90th_percentile":713.44,"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":"252","median_amount":219.57,"10th_percentile":77.2,"90th_percentile":441.83,"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 ($): FEE SCHEDULE]","count":"44","median_amount":205.42,"10th_percentile":94.24,"90th_percentile":380.34,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"4314","median_amount":1623.0,"10th_percentile":473.22,"90th_percentile":4208.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"505","median_amount":543.9,"10th_percentile":152.6,"90th_percentile":1317.35},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"48","median_amount":237.99,"10th_percentile":107.92,"90th_percentile":512.12,"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":"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":"102","median_amount":271.62,"10th_percentile":45.27,"90th_percentile":572.1,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"15","median_amount":250.84,"10th_percentile":70.0,"90th_percentile":456.35,"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 ($): FEE SCHEDULE]","count":"1844","median_amount":203.56,"10th_percentile":74.8,"90th_percentile":463.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"127","median_amount":192.15,"10th_percentile":66.7,"90th_percentile":464.73,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"127","median_amount":283.26,"10th_percentile":81.98,"90th_percentile":594.6,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":250.76,"10th_percentile":173.16,"90th_percentile":351.12,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"63","median_amount":277.08,"10th_percentile":92.36,"90th_percentile":496.82,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":238.06,"10th_percentile":238.06,"90th_percentile":308.1,"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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1049","median_amount":595.0,"10th_percentile":216.46,"90th_percentile":2025.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"198","median_amount":804.0,"10th_percentile":268.0,"90th_percentile":2412.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"700","median_amount":203.46,"10th_percentile":76.67,"90th_percentile":457.41,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":279.05,"10th_percentile":279.05,"90th_percentile":279.05,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":110.36,"10th_percentile":110.36,"90th_percentile":110.36,"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":"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1072","median_amount":824.4,"10th_percentile":189.56,"90th_percentile":824.4,"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":"28","median_amount":89.96,"10th_percentile":80.97,"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 ($): FEE SCHEDULE]","count":"654","median_amount":116.1,"10th_percentile":116.1,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":144.15,"10th_percentile":144.15,"90th_percentile":144.15,"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] [APC ($): FEE SCHEDULE]","count":"971","median_amount":1374.0,"10th_percentile":1374.0,"90th_percentile":1374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"23","median_amount":148.09,"10th_percentile":148.09,"90th_percentile":1374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"14","median_amount":1374.0,"10th_percentile":1374.0,"90th_percentile":1374.0},{"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":"800","median_amount":89.96,"10th_percentile":77.73,"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":"176","median_amount":116.1,"10th_percentile":116.1,"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":"BCBS","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"21","median_amount":110.18,"10th_percentile":110.18,"90th_percentile":110.18,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"6038","median_amount":1374.0,"10th_percentile":1338.55,"90th_percentile":1374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"722","median_amount":480.9,"10th_percentile":452.2,"90th_percentile":480.9},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"52","median_amount":116.1,"10th_percentile":116.1,"90th_percentile":119.48,"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":"[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":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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.48,"10th_percentile":119.48,"90th_percentile":119.48,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":104.49,"10th_percentile":104.49,"90th_percentile":104.49,"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 ($): FEE SCHEDULE]","count":"1339","median_amount":116.1,"10th_percentile":116.1,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"50","median_amount":112.63,"10th_percentile":112.63,"90th_percentile":115.9,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":116.1,"10th_percentile":116.1,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"12","median_amount":88.1,"10th_percentile":82.58,"90th_percentile":91.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","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":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":116.1,"10th_percentile":116.1,"90th_percentile":116.1,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1332","median_amount":332.0,"10th_percentile":316.0,"90th_percentile":332.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"232","median_amount":328.0,"10th_percentile":328.0,"90th_percentile":328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"488","median_amount":116.11,"10th_percentile":116.11,"90th_percentile":116.11,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":119.48,"10th_percentile":119.48,"90th_percentile":1374.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"1 through 10","median_amount":783.0,"10th_percentile":434.45,"90th_percentile":1558.8,"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":"0","additional_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 ($): FEE SCHEDULE]","count":"32","median_amount":174.86,"10th_percentile":81.26,"90th_percentile":339.58,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":1168.37,"10th_percentile":953.0,"90th_percentile":1259.85,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":115.43,"10th_percentile":30.0,"90th_percentile":180.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"12","median_amount":283.26,"10th_percentile":130.38,"90th_percentile":358.87,"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":"1 through 10","median_amount":222.16,"10th_percentile":182.7,"90th_percentile":274.06,"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":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"47","median_amount":1056.0,"10th_percentile":352.0,"90th_percentile":1831.61,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"1 through 10","median_amount":556.5,"10th_percentile":556.5,"90th_percentile":556.5},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":372.13,"10th_percentile":372.13,"90th_percentile":372.13,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"41","median_amount":118.06,"10th_percentile":42.5,"90th_percentile":227.64,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_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":373.8,"10th_percentile":373.8,"90th_percentile":373.8,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"13","median_amount":405.0,"10th_percentile":405.0,"90th_percentile":675.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":804.0,"10th_percentile":804.0,"90th_percentile":804.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":183.51,"10th_percentile":141.41,"90th_percentile":275.24,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"112","median_amount":916.8,"10th_percentile":207.71,"90th_percentile":975.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, 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":86.37,"10th_percentile":86.37,"90th_percentile":321.51,"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 ($): FEE SCHEDULE]","count":"109","median_amount":103.3,"10th_percentile":103.3,"90th_percentile":127.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":167.89,"10th_percentile":167.89,"90th_percentile":167.89,"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] [APC ($): FEE SCHEDULE]","count":"144","median_amount":931.0,"10th_percentile":897.0,"90th_percentile":1625.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"13","median_amount":45.0,"10th_percentile":25.0,"90th_percentile":142.36,"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":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":897.0,"10th_percentile":897.0,"90th_percentile":897.0},{"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":89.96,"10th_percentile":86.37,"90th_percentile":147.63,"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":"32","median_amount":105.3,"10th_percentile":103.3,"90th_percentile":129.22,"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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":120.73,"10th_percentile":120.73,"90th_percentile":182.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"748","median_amount":1459.76,"10th_percentile":897.0,"90th_percentile":1625.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"77","median_amount":323.85,"10th_percentile":313.95,"90th_percentile":568.75},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":127.22,"10th_percentile":103.3,"90th_percentile":207.36,"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":"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":86.37,"10th_percentile":86.37,"90th_percentile":185.69,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":114.5,"10th_percentile":114.5,"90th_percentile":114.5,"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 ($): FEE SCHEDULE]","count":"176","median_amount":103.51,"10th_percentile":103.3,"90th_percentile":127.22,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":88.32,"10th_percentile":86.37,"90th_percentile":98.72,"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":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":89.96,"10th_percentile":86.37,"90th_percentile":627.62,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":91.76,"10th_percentile":91.76,"90th_percentile":91.76,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"137","median_amount":332.0,"10th_percentile":265.6,"90th_percentile":332.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"23","median_amount":328.0,"10th_percentile":328.0,"90th_percentile":328.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"67","median_amount":127.24,"10th_percentile":103.32,"90th_percentile":127.64,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"43","median_amount":14.56,"10th_percentile":7.28,"90th_percentile":43.88,"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":"1 through 10","median_amount":5.5,"10th_percentile":3.69,"90th_percentile":7.92,"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":"[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] [APC ($): FEE SCHEDULE]","count":"50","median_amount":206.18,"10th_percentile":146.49,"90th_percentile":272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed 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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":22.78,"10th_percentile":22.78,"90th_percentile":1467.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"0","additional_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":"170","median_amount":7.92,"10th_percentile":5.28,"90th_percentile":8.25,"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":"0","additional_payer_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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"335","median_amount":249.0,"10th_percentile":155.31,"90th_percentile":272.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"44","median_amount":66.47,"10th_percentile":40.95,"90th_percentile":75.95},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":5.5,"10th_percentile":5.28,"90th_percentile":8.25,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":124.99,"10th_percentile":124.99,"90th_percentile":124.99,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Meridian","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_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":8.25,"10th_percentile":5.28,"90th_percentile":17.45,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":8.42,"10th_percentile":8.42,"90th_percentile":8.42,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"63","median_amount":13.46,"10th_percentile":10.14,"90th_percentile":31.96,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":16.82,"10th_percentile":10.14,"90th_percentile":42.93,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"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 Surgery (%BC): 60 Maximum Reimbursement 8570] [Cardiac Cath (%BC): 60 Maximum Reimbursement 8570] [Observation (%BC): 60 Maximum Reimbursement 3895] [Emergency Department (%BC): 60 Maximum Reimbursement 3895] [CT Scan OP ($): 1093] [MRI OP ($): 1560] [Laboratory Fee Schedule: FEE SCHEDULE] [Occupational Therapy (%BC): 60] [Physical Therapy (%BC): 60] [Respiratory Services/Therapy (%BC): 60] [Speech Therapy (%BC): 60] [OP High Cost Drugs (%BC): 13.2] [Other Outpatient Implant (%BC): 16.9] [All Other OP (%BC): 60]","count":"58","median_amount":1673.4,"10th_percentile":595.65,"90th_percentile":1718.4,"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":511.24,"10th_percentile":511.24,"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":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"11","median_amount":366.32,"10th_percentile":359.52,"90th_percentile":367.83,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Aetna","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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] [APC ($): FEE SCHEDULE]","count":"59","median_amount":9320.0,"10th_percentile":9161.6,"90th_percentile":9800.63,"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":"[OP Surgery (%BC): 22.90 Maximum Reimbursement 9367.13] [Observation (%BC): 22.90 Maximum Reimbursement 7805.99] [Emergency Department (%BC): 22.04] [Occupational Therapy (%BC): 22.04] [Physical Therapy (%BC): 22.04] [Respiratory Services/Therapy (%BC): 22.04] [Speech Therapy (%BC): 22.04] [All Other OP (%BC): 22.04]","count":"1 through 10","median_amount":50.0,"10th_percentile":50.0,"90th_percentile":200.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"BCBS","plan_name":"HPN Other Commercial Plan","methodology":"percent of total billed charges","standard_charge_percentage":22.95,"count":"1 through 10","median_amount":9020.0,"10th_percentile":9020.0,"90th_percentile":9020.0},{"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":"55","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":"BCBS","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":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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"BCBS","plan_name":"PPO","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surgery (%BC): 24.42] [Observation (%BC): 24.42 Maximum Reimbursement 8311.63] [Emergency Department (%BC): 24.42 Maximum Reimbursement 7500] [Radiology Fee Schedule: FEE SCHEDULE] [Laboratory Fee Schedule: FEE SCHEDULE] [OP High Cost Drugs Fee Schedule: FEE SCHEDULE] [All Other OP (%BC): 24.42]","count":"352","median_amount":9320.0,"10th_percentile":8813.31,"90th_percentile":9620.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Cigna","plan_name":"All Commercial Plans","methodology":"percent of total billed charges","standard_charge_percentage":35.0,"count":"31","median_amount":2947.0,"10th_percentile":485.0,"90th_percentile":2947.0},{"payer_name":"Cigna","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"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":511.24,"10th_percentile":511.24,"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":"Devoted Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Essence Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): 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 ($): FEE SCHEDULE]","count":"1 through 10","median_amount":367.83,"10th_percentile":21.83,"90th_percentile":372.78,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Humana","plan_name":"MMAI Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"1 through 10","median_amount":355.33,"10th_percentile":355.33,"90th_percentile":355.33,"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":"1 through 10","median_amount":511.24,"10th_percentile":511.24,"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 ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Molina Healthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"1 through 10","median_amount":521.46,"10th_percentile":521.46,"90th_percentile":521.46,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"Molina Healthcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"PPHP","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"UnitedHealthCare","plan_name":"All Commercial Plans","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): FEE SCHEDULE] [OP Surg. Group 1 ($): FEE SCHEDULE] [OP Surg. Group 2 ($): FEE SCHEDULE] [OP Surg. Group 3 ($): FEE SCHEDULE] [OP Surg. Group 4 ($): FEE SCHEDULE] [OP Surg. Group 5 ($): FEE SCHEDULE] [OP Surg. Group 6 ($): FEE SCHEDULE] [OP Surg. Group 7 ($): FEE SCHEDULE] [OP Surg. Group 8 ($): FEE SCHEDULE] [OP Surg. Group 9 ($): FEE SCHEDULE] [OP Surg. Group 10 ($): FEE SCHEDULE] [OP Surg. Ungroupable ($): 3886] [Stereotactic Radiosurgery ($): 22906] [Stereotactic Radiosurgery-Fractionated ($): 5062] [Observation ($): 4393] [ED Level 1--99281 ($): 412] [ED Level 2--99282 ($): 637] [ED Level 3--99283 ($): 973] [ED Level 4--99284 ($): 1497] [ED Level 5--99285 ($): 2023] [Critical Care ($): 2769] [Urgent Care ($): 460] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 934] [Cardiology ($): 857] [Echocardiology ($): 831] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 607] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3025] [Sleep Studies-Unattended ($): 1155] [Chemotherapy ($): 1204] [Nuclear Medicine ($): 1620] [Oncology (%BC): 62] [Radiation Therapy ($): 768] [CT Scan OP ($): 1799] [MRI OP ($): 2366] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 166] [Mammography-Screening ($): 166] [Positron Emission Tomography ($): 2502] [Radiology ($): 389] [Ultrasound Imaging ($): 686] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 135] [Physical Therapy ($): 135] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 135] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 301] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"72","median_amount":2366.0,"10th_percentile":1939.18,"90th_percentile":2366.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Core/Navigate Other Commercial Plan","methodology":"other","standard_charge_algorithm":"[Lesser Than Charges paid at %: 100] [OP Surg. Group 0 ($): 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 ($): 3858] [Stereotactic Radiosurgery ($): 22742] [Stereotactic Radiosurgery-Fractionated ($): 5025] [Observation ($): 4362] [ED Level 1--99281 ($): 409] [ED Level 2--99282 ($): 632] [ED Level 3--99283 ($): 966] [ED Level 4--99284 ($): 1486] [ED Level 5--99285 ($): 2008] [Critical Care ($): 2749] [Urgent Care ($): 457] [Cardiac Rehabilitation Therapy (%BC): 62] [Cardiac Stress Test ($): 928] [Cardiology ($): 851] [Echocardiology ($): 825] [EKG/ECG (%BC): 62] [Holter Monitor/Telemetry (%BC): 62] [Peripheral Vascular Lab ($): 602] [EEG (%BC): 62] [EMG (%BC): 62] [MEG (%BC): 62] [Neuropsychological Testing and Biofeedback (%BC): 62] [Sleep Studies-Attended ($): 3004] [Sleep Studies-Unattended ($): 1147] [Chemotherapy ($): 1195] [Nuclear Medicine ($): 1609] [Oncology (%BC): 62] [Radiation Therapy ($): 762] [CT Scan OP ($): 1786] [MRI OP ($): 2349] [Imaging Services (%BC): 62] [Mammography-Diagnostic ($): 164] [Mammography-Screening ($): 164] [Positron Emission Tomography ($): 2485] [Radiology ($): 386] [Ultrasound Imaging ($): 681] [Laboratory Fee Schedule: FEE SCHEDULE] [Pathology Fee Schedule: FEE SCHEDULE] [Reference Lab Fee Schedule: FEE SCHEDULE] [Hemodialysis (%BC): 62] [Peritoneal Dialysis, CAPD, and CCPD (%BC): 62] [Occupational Therapy ($): 134] [Physical Therapy ($): 134] [Respiratory Services/Therapy (%BC): 62] [Speech Therapy ($): 134] [OP High Cost Drugs ($): 0 Charge Threshold 5524 (%BC): 33] [Other Outpatient Implant ($): 0 Charge Threshold 6264 (%BC): 50] [Hyperbarics (%BC): 62] [IV Therapy ($): 298] [Pulmonary Function (%BC): 62] [Pulmonary Rehabilitation (%BC): 62]","count":"1 through 10","median_amount":2349.0,"10th_percentile":2349.0,"90th_percentile":2366.0,"additional_payer_notes":"Contracting method is an algorithm described in the 'standard_charges|algorithm' field. The allowed amount provided accounts for the structural rates, conditions, and utilization elements inherent in the payer's algorithm."},{"payer_name":"UnitedHealthCare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"14","median_amount":367.84,"10th_percentile":246.94,"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":"Wellcare","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Youthcare","plan_name":"Medicaid Managed Care Plan","methodology":"other","standard_charge_algorithm":"[Outpatient Services: Payer leverages state specific Medicaid payment methodology. Available, referenceable algorithm logic found here: https://hfs.illinois.gov/medicalproviders/medicaidreimbursement/hospital]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."},{"payer_name":"Zing Health","plan_name":"Medicare Managed Care Plan","methodology":"other","standard_charge_algorithm":"[APC ($): FEE SCHEDULE]","count":"0","additional_payer_notes":"No services performed during 15-month lookback period."}]}]},{"description":"Ketorolac tromethamine inj","code_information":[{"code":"J1885","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":0.34,"maximum":0.55,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":0.34,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":0.55,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx, non-str,Yttrium-90","code_information":[{"code":"C2616","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":17771.01,"maximum":28629.10,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee schedule","standard_charge_dollar":17771.01,"additional_payer_notes":"APC"},{"payer_name":"BCBS","plan_name":"Choice Other Commercial Plan","methodology":"fee schedule","standard_charge_dollar":28629.1,"additional_payer_notes":"APC"}]}]},{"description":"Brachytx, non-stranded,P-103","code_information":[{"code":"C2641","type":"HCPCS"}],"standard_charges":[{"setting":"outpatient","billing_class":"facility","minimum":64.48,"maximum":103.88,"payers_information":[{"payer_name":"Aetna","plan_name":"Medicare Managed Care Plan","methodology":"fee 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